What would you do if you had to pay tuition for Residency?

[JohnMadden]

What are your thoughts? Would you still go in to medicine?

Many healthcare policy analysts have proposed that the residents should incur some of the costs associated with pursuing their graduate medical education. Currently, the government pays for most of these costs...

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[Navicular]

What are your thoughts? Would you still go in to medicine?

Many healthcare policy analysts have proposed that the residents should incur some of the costs associated with pursuing their graduate medical education. Currently, the government pays for most of these costs...

That would be absurd. Medical students have already incurred a huge amount of debt from their undergraduate and medical education. They make next to nothing as a resident working 70+ hours per week. I'd say the government is getting a VERY good deal from paying residents so little to do so much. You could make more at the McDonald's across the street from the hospital.

 

[JohnMadden]

That's just one estimate, however, from a Health Affairs journal article discussing ways to fund GME.

 

[Eric Lindros]

What are your thoughts? Would you still go in to medicine?

Many healthcare policy analysts have proposed that the residents should incur some of the costs associated with pursuing their graduate medical education. Currently, the government pays for most of these costs...

why not. bring on the pain, we all love it

 

[alwaysaangel]

That's just one estimate, however, from a Health Affairs journal article discussing ways to fund GME.

Hmmm...pay to work like a dog. There is a line and that would be it...they're already getting dirt cheap labor out of residents - I really doubt they will force us to pay for the pleasure anytime soon.

 

[Biostats.moore]

hahahah...no pain, no gain.

 

[BellyDancingDoc]

What are your thoughts? Would you still go in to medicine?

Many healthcare policy analysts have proposed that the residents should incur some of the costs associated with pursuing their graduate medical education. Currently, the government pays for most of these costs...

I'd still go into medicine, but my decision tree in choosing a school would change a lot. Right now, cost is a factor, but I'm still willing for pay a few $K more/year for the program that fits best. If this change were to happen, I'd go to the absolute cheapest place I could possibly find.

Oh yeah, and I'd spend any free time fighting to get the rule changed back for future generations. These debt loads are terrible for young doctors; even the most idealistic folks are forced to choose a specialty that will help them pay off their debts as opposed to a specialty in which good doctors are most needed.

 

[Sol Rosenberg]

No way would I do this. Residents are basically cheap labor now (residency is a JOB, not a course of study) so requiring them to pay to work would be ridiculous. There is no other professional job that requires this. Becoming a midlevel would be a much more attractive option for those interested in primary care. People are complaining about massive amounts of debt NOW, let alone if the number of years without any income (and worse, extra "tuition" for residency) were doubled or worse. What about Neurosurg. residents who have 7 years of residency? If they had to pay for their residency they would be financially fracked unless they/their families were independently wealthy.

So, my answer to the direct question is that there is no way I would become a doctor under those circumstances, but, these circumstances are not going to happen, IMHO.

 

[baylormed]

No way would I do it.

Basically, hospitals are getting a doctor (albeit one in training) that works 60-80 hours/week for ~40K/year. And they want to pay them less?

 

[zimmie256]

What are your thoughts? Would you still go in to medicine?

Many healthcare policy analysts have proposed that the residents should incur some of the costs associated with pursuing their graduate medical education. Currently, the government pays for most of these costs...

Run, run as fast and as far as I can......

 

[pyrois]

What are your thoughts? Would you still go in to medicine?

Many healthcare policy analysts have proposed that the residents should incur some of the costs associated with pursuing their graduate medical education. Currently, the government pays for most of these costs...

I don't think the question should be "what would we do" but what would the companies that loan us money do?

To be honest, if those big banks crunch the numbers and are still willing to loan med students upwards of $400,000 over a span of 8-10 years without us paying back a dime until the end, then count me in.

If they think we can pay it off, then we can pay it off

 

[Creightonite]

Actually, residency programs get funding of $70k per resident/per year. They give $40k to the residents and keep $30k for themselves.

 

[VandyXGirl]

No way would I do this. Residents are basically cheap labor now (residency is a JOB, not a course of study) so requiring them to pay to work would be ridiculous. There is no other professional job that requires this. Becoming a midlevel would be a much more attractive option for those interested in primary care. People are complaining about massive amounts of debt NOW, let alone if the number of years without any income (and worse, extra "tuition" for residency) were doubled or worse. What about Neurosurg. residents who have 7 years of residency? If they had to pay for their residency they would be financially fracked unless they/their families were independently wealthy.

So, my answer to the direct question is that there is no way I would become a doctor under those circumstances, but, these circumstances are not going to happen, IMHO.

I completely agree. Medical residents have the same difficulty in categorizing themselves as graduate students do. Are you a student or an employee? You are earning a stipend/income but you are also still learning (obviously) and you have to undergo this training in order to advance in your career. Also both groups work insane hours and end up getting paid maybe minimum wage for 4 years. Medical residents often use many student amenities (like the student gym) but they also get employee perks (like better parking!) I think if people had to start paying for graduate school (especially in the sciences) they wouldn't go and the same would happen in residency. Truth of the matter is, no one can survive being unpaid for 8+ years after high school. Having to pay $60,000/yr on top of that would be unsustainable. If you want to encourage people to become doctors especially in the fields that we need, then you have to make it affordable/desirable on some level.

 

[chad5871]

I consider residency on-the-job training. In every other profession, this is usually paid for, with the trainee also earning a small salary.

 

[punkindrublic]

I'd like to see those health policy analysts repeat that opinion when they're on a 6 year waitlist for a heart surgeon.

I'd also like to see a link to someone advocating this view, it's one I've never heard.

I'm sure you can tell from the bitterness of my response I think this is one of the most asinine ideas I've ever heard. Residents do incur the full cost of their education; it's paid off in 80-hour workweeks at $40k a year. I'm sure it's been calculated, but what is the "market value" of a resident in hours and billable work (that would otherwise have to be done by a fully-licensed doc)? My guess is that it is far far more than the $40k + "tuition" that would be charged under a traditional kind of payment system.

 

[dutchman]

Don't let Panda see this thread. Who is suggesting that crap? They need to show their face so we can settle this thing with bare knuckles. Pay for slavery? You are kidding, right?

 

[spicedmanna]

What are your thoughts? Would you still go in to medicine?

Many healthcare policy analysts have proposed that the residents should incur some of the costs associated with pursuing their graduate medical education. Currently, the government pays for most of these costs...

Those analysts are freaking tools for making that suggestion, and what they suggest amounts to highway robbery. It won't even crawl. Residents are practically volunteers as it is. I think these so-called analysts should try to get off their freaking intellectual pedestals and work an 80 hr week with call, and then let me know if they are willing to pay $15K a year for that kind of torture. Uh huh, I didn't think so.

 

[p9142]

What are your thoughts? Would you still go in to medicine?

Many healthcare policy analysts have proposed that the residents should incur some of the costs associated with pursuing their graduate medical education. Currently, the government pays for most of these costs...

link?

 

[BellyDancingDoc]

link?

^^^ Seconded. Link?

 

[JohnMadden]

http://content.healthaffairs.org/cgi/reprint/16/4/48.pdf

This is an older article that mentions policy alternatives related to the cost of graduate medical education.

The recent budget proposal from President Bush proposed a signficant cut in the funding of graduate medical education funding. Because of this potential impact, policy analysts and leaders leaders are revisiting the issue of shifting GME costs.

 

[PugMD]

...time to cut and run. Ridiculous.

 

[p9142]

http://content.healthaffairs.org/cgi/reprint/16/4/48.pdf

This is an older article that mentions policy alternatives related to the cost of graduate medical education.

The recent budget proposal from President Bush proposed a signficant cut in the funding of graduate medical education funding. Because of this potential impact, policy analysts and leaders leaders are revisiting the issue of shifting GME costs.

I am by no means a political expert, but he can propose whatever he wants but it is up to Congress to actually make the budget. It is hard for me to believe that democrats would cut education, but I am still fuming after what they did with student loan rates (VOTE LIBERTARIAN!!!!) Anyways, Bush is the lamest of lame ducks, and I don't think we should worry about anything he says.

 

[sirus_virus]

Residency is free labor and they know it. No one is going to allow you make a transition from slave to paying customer, so you guys need to stop wishing. Do you think residents will be as compliant if they were paying for a pediatrics residency, and also, how much will residents pay for a competitive specialty as opposed to a noncompetitive one? It is not like medschool where they can always turn arround and pick the next candidiate. The supply is actually limited at that point. Also goodluck telling Foreign medical graduates to pay some hard core dollars for residency, especially since they don't qualify for loans. I laugh at that ridiculous proposal.

 

[physicsnerd42]

What would you do if you had to pay tuition for Residency?

Research.

 

[melissainsd]

Honestly by the end of this process they will have broken my spirit to the point that I would pay.

 

[MirrorTodd]

I'd go active army and become SF.

 

[Mr. McDuck]

I'd move to Europe.

 

[45408]

Sounds like biggest bullsh.t suggestion ever. If working for $8/hr for 80 hours a week with a doctorate degree (that cost $150,000+) isn't paying for your education, I don't know what is. Why don't we make nurses pay to work at the hospital too?

 

[JohnMadden]

I'm not 100% sure, but don't residents in Canada pay tuition?

 

[Wizard of Oz]

Actually, residency programs get funding of $70k per resident/per year. They give $40k to the residents and keep $30k for themselves.

Only in America...

This isn't really true. They are given extra for health insurance and benefits, but typically the money goes through an educational institution after it comes from a healthcare agency. Who the "themselves" is remains a question to me.

There is an issue over whether or not they should be treated as students or employees when it comes to health insurance billing and FICA deductions.

 

[lilnoelle]

I wouldn't do it. If this really happened I would do my intern year and then I'd go be a GP in a rural area.

 

[tp709]

Pay EIGHT YEARS of tuition?!?!?!?! WTf!!

 

[Gut Shot]

What are your thoughts?

"Have you been thinking about killing yourself?"

"No. I've been thinking about killing a whole lot of people and then killing myself."

 

[8744]

Don't let Panda see this thread. Who is suggesting that crap? They need to show their face so we can settle this thing with bare knuckles. Pay for slavery? You are kidding, right?

Oh man. This thread pisses me off like no other. As you folks may or may not know, in six years on SDN I have never been on probation or banned because not only am I a polite fellow but I also don't believe in writing anything I wouldn't say to somebody's face.

It's my creed.

But I gotta tell ya', making residents pay for their training under the current system is the most asinine idea I have ever heard and I am fixing to start calling out those who advocate it.

Good Lord. Not only does my hospital get close to $140,000 dollars per year for me from medicare but they do, in fact, make money off my labor, first because the exploitation of their captive corral of indentured servants allows them to avoid hiring either expensive physicians or not-so-expensive-but-still pricey PAs to do all of their work. Second, because we do actually perform de novo money-making services. At one of our hospitals, on our medicine rotation, all we do is crank out admissions so the private services don't have to pay someone to do it. The attending comes in the morning, "Agrees with our assessement and plan, and collects the full amount for a minimum of work. If he had to admit 15 patients a night not only would he not do it but he'd have to hire somebody at close to $100 bucks per hour (the going rate for a hospitalist).

Instead, I get paid ten bucks an hour and he pays nothing except some notional lost productivity from barely noticable teaching.

How much, for that matter, should we pay? Should I pay $40,000 a year? More? Less? On what basis? Because some jackass accountant can fudge the numbers to show that having residents results in a net loss for the hospital.

If I had to pay for residency not only would I not have gone into medicine but I would be laughing at the mother-****ers who were stupid enough to get ass-raped in medical school like prison biaches and then go back for more. Is there no indignity, no humilation that you folks won't endure for your obsession for a career that most of you won't even like that much once you get into the trenches?

You know, it is ass-kissing zealots who would sell their mothers to get into medical school and work as physicians for less than a garbageman who ruin it for everybody. Can't you little ****wads play a little hard to get? Jeez. You're like a bunch of five-dollar hookers on dollar night.

 

[8744]

I completely agree. Medical residents have the same difficulty in categorizing themselves as graduate students do. Are you a student or an employee? You are earning a stipend/income but you are also still learning (obviously) and you have to undergo this training in order to advance in your career. Also both groups work insane hours and end up getting paid maybe minimum wage for 4 years. Medical residents often use many student amenities (like the student gym) but they also get employee perks (like better parking!) I think if people had to start paying for graduate school (especially in the sciences) they wouldn't go and the same would happen in residency. Truth of the matter is, no one can survive being unpaid for 8+ years after high school. Having to pay $60,000/yr on top of that would be unsustainable. If you want to encourage people to become doctors especially in the fields that we need, then you have to make it affordable/desirable on some level.

Let me clarify it for you. It's an income or a stipend depending on when it is covenient for the hospital. When it comes to working long hours and being sleep deprived, something no other employee in any other job would tolerate for a minute it's a stipend. When it comes to taxes, accounting, and the hospitals balance sheet it's income.

Oh, and graduate students do very little useful work, at least work that can be quantified. If I had a week or so I could pull all of my charts for the last month and show you exactly how much money I have made for the hospital. Here's the scenario: We have one attending signing off and reviewing the charts of anywhere from three to five residents at any time. Granting that we are a little slower than fully trained EM attendings (but not that much slower) it's as if the hospital has hired one or possibly two extra attendings and, instead of paying $240,000 per year pay only about $50,000 (if you figure in our benefiits). Not only that but as medicare pays them $140,000 per resident per year they make a $90,000 profit on top of everything else. We are literally no-cost slave labor.

And don't kid yourself. Every patient I see is billed as if the attending saw him exclusively. They don't bill less because the majority of the work was done by one of their slaves.

 

[8744]

I completely agree. Medical residents have the same difficulty in categorizing themselves as graduate students do. Are you a student or an employee? You are earning a stipend/income but you are also still learning (obviously) and you have to undergo this training in order to advance in your career. Also both groups work insane hours and end up getting paid maybe minimum wage for 4 years. Medical residents often use many student amenities (like the student gym) but they also get employee perks (like better parking!) I think if people had to start paying for graduate school (especially in the sciences) they wouldn't go and the same would happen in residency. Truth of the matter is, no one can survive being unpaid for 8+ years after high school. Having to pay $60,000/yr on top of that would be unsustainable. If you want to encourage people to become doctors especially in the fields that we need, then you have to make it affordable/desirable on some level.

It would be the end of medicine as a profession. At a minimum most people would be borrowing money for eleven years...or thirteen if they wanted to be a surgeon. Who, even the most flaming of zealots, would do this?

 

[DropkickMurphy]

Wow, this thread hasn't turned into a altruism version of "Who's packing a bigger dick?" battle royale. I'm shocked by that. I swear these threads with doom and gloom predictions are started by gunners who are just trying to scare off those who are serious competition that they can't eliminate through more direct means.

 

[45408]

Pay EIGHT YEARS of tuition?!?!?!?! WTf!!

eight? you're already paying eight remember college? More like 12-15 years of tuition

 

[gary5]

What a joke. Lawyers make $100,000 after a mere 3 years of school and they don't even know much at that point. Residents should be paid the same $100k. If hospitals had to pay for residents, then they would utilize them instead of using them as cheap labor.

 

[TMP-SMX]

DMC depends on the cheap labor of residents. (Especially those from Wayne State). Hospitals are quite happy about the situation right now.

 

[soeagerun2or]

Major markets aside I see the first years of practice for lawyers much like that of the residency years for physicians. E.g. they spend 5 years making $40-60k/year to earn their keep to make $200k-1+million/year. While there isn't a federal program to support lawyers in their training as there is doctors I'd pose the question which would we be worse without? And as several have stated earlier in the thread, most programs actually make money off of residents because they are, in fact, more qualified, cheaper, and better insured labor than PAs/NPs.

What it comes down to is that there is no way you could ever make a resident pay for his/her education because most educational institutions realize residents are necesary for the exceptionally low pay they provide their attendings. Not just that but residents are a welcome source of revenue. End of story.

This is a rahter silly idea to begin with

 

[gary5]

What a crock of ****. I swear to God, I'm going to urinate on the next SDN user who propogates this ******ed myth.

I know a lawyer who started at over $100k. Of course, she had to work for a law firm, as opposed to working for govt.

 

[dr kevin40]

Major markets aside I see the first years of practice for lawyers much like that of the residency years for physicians. E.g. they spend 5 years making $40-60k/year to earn their keep to make $200k-1+million/year. While there isn't a federal program to support lawyers in their training as there is doctors I'd pose the question which would we be worse without? And as several have stated earlier in the thread, most programs actually make money off of residents because they are, in fact, more qualified, cheaper, and better insured labor than PAs/NPs.

What it comes down to is that there is no way you could ever make a resident pay for his/her education because most educational institutions realize residents are necesary for the exceptionally low pay they provide their attendings. Not just that but residents are a welcome source of revenue. End of story.

This is a rahter silly idea to begin with

I definitely would say this is incorrect as regarding lawyer salary straight out of law school. Most corporate law firms (and believe me there are many) START their grads at 120k first year outta school. And its definitely true that most are still learning on the job. Now, it takes about 6-10 years to make partner, and even within partner there are varying levels (from general partner, to those with actual ownership). But keep in mind, every year your salary increases on the average of 15-40k so by 6th year, usually making 250+ base salary. THe best part? there's bonuses in addition to these base salaries...Now, A general partner can expect to make 400k+, and owernship means 1-2M and possibly more. Of course, each firm has different standars and levels of difficulty to obtain each partnership, but on average out of a first year class of 40 new associates, 2-3 will make partner.

More recently, in order to recruit the "best talent" sevearl law offices have upped the ante to 160k in markets like NYC and DC for first year grads. Again all this is referring to corp law.

As far as small noncorp law firms, salary can vary widely from 40-100k but as a general rule less than corp firms.

 

[DropkickMurphy]

I know a lawyer who started at over $100k. Of course, she had to work for a law firm, as opposed to working for govt.

I take it you're not up to speed on the theory of evidence based practice.

Yes your friend makes $100K+ straight out of law school, but that's probably not an average for a new lawyer with zero experience and the salary range is far less stable in law than in healthcare; you get through med school and you're pretty much guaranteed at least $120K a year even if you are bottom of your class and wind up as an FP. That isn't true with law school, especially if you aren't going to be in a huge city.

 

[MirrorTodd]

I take it you're not up to speed on the theory of evidence based practice.

Yes your friend makes $100K+ straight out of law school, but that's probably not an average for a new lawyer with zero experience and the salary range is far less stable in law than in healthcare; you get through med school and you're pretty much guaranteed at least $120K a year even if you are bottom of your class and wind up as an FP. That isn't true with law school, especially if you aren't going to be in a huge city.

Nah-ah, but, but, but Dropkick I know of plenty of FP's who are making ~90k a year. What you said is total bullcrap. Look at this chart that shows pay scales for attendings per specialty. *inserts chart* It's totally possible that we won't make enough to live.

 

[DropkickMurphy]

Nah-ah, but, but, but Dropkick I know of plenty of FP's who are making ~90k a year. What you said is total bullcrap. Look at this chart that shows pay scales for attendings per specialty. *inserts chart* It's totally possible that we won't make enough to live.

If the gloom and doom predictions were to come true, this is what medicine at your average hospital would be like:

 

[lilnoelle]

I know a lawyer who started at over $100k. Of course, she had to work for a law firm, as opposed to working for govt.

Well I know a lawyer who has all the qualifications to eventually be the governor of Iowa, she's been out of law school over a year and can't find a job. That must mean that all lawyers are jobless.

 

[Law2Doc]

I take it you're not up to speed on the theory of evidence based practice.

Yes your friend makes $100K+ straight out of law school, but that's probably not an average for a new lawyer with zero experience and the salary range is far less stable in law than in healthcare; you get through med school and you're pretty much guaranteed at least $120K a year even if you are bottom of your class and wind up as an FP. That isn't true with law school, especially if you aren't going to be in a huge city.

Here's the skinny. Starting salaries of lawyers right out of law school at large law firms in major cities are about $140k. The average starting salary for lawyers right out of law school nationally is about $40k. The range is huge -- the lowest full time law position I have heard of makes $20k (legal aid in non-competitive state). But you have to realize that there are many many more law schools out there, all with significantly larger classes, and thus many more law graduates out there -- so there is a huge range of salaries. The number of lawyers in the US dwarfs the number of MDs several times over, making any comparison of "averages" an apples and oranges comparison -- it is very different to be average in law than medicine in terms of the number of people down the list you are. So, if, looking from the top salaries down, you took the equivalent number of law grads to allo grads (16,000), the average starting salary of this group of lawyers would be close to, if not exceeding, $100k, I would think. At any rate, you can do very well in law right out of law school if you have the same kind of smarts that would get you into med school (speaking from my own experience). But if you don't have that kind of smarts, you can probably still become a lawyer (unlike a doctor), which is in part why the range is so great.

 

[JohnMadden]

This is not a doom and gloom thread by any means. I heard this idea proposed at an academic medical center while working on a consulting engagement. I was intrigued and slightly disturbed by the idea so I contacted some of my old health policy colleagues. This "asinine" idea has been proposed by seemingly intelligent and well educated people.

Was anyone able to find out if there are tuition costs for residents in Canada?

One of the arguments made for shifting some of the costs associated with GME in the U.S. relates to the increased liability/malpractice insurance for residents and the mistakes that they will make while learning. Do I think this justifies tuition? Heck No. However, while everyone talks about how hospitals are "getting over", it is important to realize that one good lawyer can set a hospital back a few million pretty quickly for a resident's mistakes (in larger cities). I would imagine that residents on average make more mistakes that attendings, but I have no data to support this thought.

 

[chad5871]

What a crock of ****. I swear to God, I'm going to urinate on the next SDN user who propogates this ******ed myth.

My brother is in law school. He just got an offer for an internship next summer for $2200/week. I guess an internsihp is different, but that's over $110,000 a year. My brother is first in his class, though. He said that the average for lawyers out of school is more like $70k.