Why do residents get paid so little and have to work so hard?

[Jeff3614]

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Hakksar, nice post.

The only problem I see with your argument is that grad school is elective education, whereas a residency is required to become board certified; further, it's completely possible to acquire a PHD while holding down a full time job, which illustrates even further the disparity between the comparison. (And, not all grad programs provide stipends) I believe it's difficult to use one job profession, lawyer or grad student, as a way to show the shortcomings in another. So, for sake of arguement, let's just define residency as full time job, because that's the capicity in which residents are used.

Now, given the fact that hospitals know med school grads need a residency to practice medicine, why should they offer a salary higher than 35k a year? The only thing driving competition in residency are the specialty professions themselves. It's price fixing at it's very best. You'll notice that most residencies are comparative in salaries, even though many hospitals are significantly better funded than others, which should translate into a higher stipend for the 'students'? Right? (In this regard grad school stipends are much higher at better funded schools) The answer is obvious. Residency stipends are fixed across the board because hospitals don't have to compete for residents. And, call it a stipend or a salary or whatever you like, the hospital is still billing an insurance company the same amount weather a resident does the procedure, a nurse, a guy off the street, or an attending. The only thing I can attribute to the low ball pay is that the hospital pays the malpractice insurance of the resident, which I'm not certain about.

I personally don't have an issue with fixing the residency stipend amounts, just make them commisurate with expereince and time investment. 35 - 40k is ridiculous for a resident putting in 80 - 100 hours a week. (I'm still at a loss as to the justification of a 100 hour week for doctors? This is somehow supposed to benefit the patient?) I digress! Something has to change, either lower the amount of hours, which we know will never happen, or raise the average salary of residents. A starting resident should start at about 60k a year and maybe top off at about 70 - 75k a year. That way a resident doesn't have to live in poverty for four years and can start paying off thier loans sooner than later.

If money means that much to you go to Law School. We need less premeds obsessed over money.

I love these "you have no right to talk about money if you want to be a doctor" statements. Here's a piece of advice: Money is part of everything you do, you need it to survive, you need it to live, you need it to start and support a family, you even need it when you die. Nobody should be a slave to money, but you need to get over it and accept the fact that it's not going away. Nor should you criticize those who want to examine and debate every facet of a career choice. I respect your right to live in some third world country dispensing medical help to those who can't afford it, however, you should respect those people who choose to practice medicine with the hope of living comfortably and wanting to raise a family.

-J

 

[hakksar]

I agree that residency and grad school are not equivalent but I disagree that getting a PhD is elective education vs Residency being mandatory. If your career aspiration is to be a regular faculty member in the sciences at any major university the PhD is mandatory. I also disagree that a student pursuing a PhD can have a full time job in addition to the PhD. Most schools set time limits in how long a student can have to achieve a PhD (at UCHSC it is 7 years). Every grad student I know works over 40 hours a week (up to 80 hours a week) and it still takes them 5-7 years to achieve a PhD. In this regard they are not different. I do agree that a PhD student stipend is dependent on funding (of the PI not the funding of the school). However, if you look at residency stipends they do differ at different facilities by a substantial amount. For instance, in Emergency Medicine a first year resident makes $39,060 at Denver Health, at Highland General Hospital they make $41,236, and at Hennepin County Medical Center they make $37,296. The stipend difference between these three well respected residencies which were picked at random differ by about $4000. This is not out of line with Grad Students whose stipend may differ by a few thousand dollars depending on funding (for instance a Grad student in a well funded lab at Stanford might make $4000 more than a grad student in a less funded lab at the University of North Dakota). Thus, the discrepency is not out of line with Residency discrepencies in funding. As for the argument that it is price fixing it might be true . . . afterall both Grad Schools and Residencies know people HAVE to go through their programs in order to achieve their career goals. However, there is also the understanding that these programs provide training and consequently give you the credentials to prove it (whether that is a PhD or a Board Certification) . . . complaining about the low stipends ignores the fact that these credentials have worth and that part of your compensation is the attainment of these credentials through the program.

 

[pseudoknot]

I agree that residency and grad school are not equivalent but I disagree that getting a PhD is elective education vs Residency being mandatory. If your career aspiration is to be a regular faculty member in the sciences at any major university the PhD is mandatory.

I agree with your argument, but also don't forget that for people going into science faculty positions, the PhD is only the beginning. At least in biology and chemistry, one also has to do at least one postdoc in order to be able to apply for academic jobs, so that's another ~4 years of "training." Postdocs in biology get paid a bit less than medical residents. It's interesting because the total training time after college is about the same for science and medicine (7-10yrs for medicine, 8-10 for science), but scientists don't accumulate debt along the way, and then get paid quite a bit less once in their "career" stages. (Starting salaries for assistant professors in biology range from $45k-75k.)

 

[45408]

The bottomline is money. One of my favorite lines is if you have to ask the price of something, you can't afford it. Similarly, if you have to complain about money than you are not motivated for the right reasons.

Nothing like a pseudo-moral soap box to lecture kids over the Internet from.

Would you work for free? End of story.

 

[medic170]

Why is grad school any more elective than residency? You elect to go to grad school to get a masters degree, and you elect to do a residency to get board certification. They are both means to an end that you elect to do. On the flip side, you could say you HAVE to do a residency to get board certified just like you HAVE to go to grad school to get a grad degree. Also, I have yet to meet a PhD student at any reputable school that can work full time while pursuing the Phd. Pursuing the Phd is full time, that is why reputable programs provide stripends.

 

[Trismegistus4]

A few points based on my limited observation (note that I'm not even in med school yet, so I have no idea what I'm talking about 😉 ):

1. There's definitely a lot of tradition built up around medicine and things are done the way they are because "that's the way it's always been." I'm sure I recall someone telling me that residency as we know it was "invented" by some guy at Hopkins in the early 20th century, who had a whole philosophy built up around the necessity of spending a few years eating, drinking, and breathing nothing but medicine. Everyone knows the original idea of the house officer: "residents" actually lived in the hospital, and no one would dream of, say, getting married and having a family until they were done with residency. I was unable to find any references to this by quick Googling, but maybe someone has more details? The brainwashing still works 😀 --my uncle, who did an IM residency in the late 80's at a highly reputable university hospital, and says that even by then residency had been much softened, absolutely bristles at any suggestion to limit resident work hours. As to the pay, those who have alluded to price fixing and monopolies have it right. There's no reason for hospitals to offer more, since they form a cartel that has a monopoly on the path to becoming a physician.

2. Some people are questioning whether much of residency is really necessary, and suggesting it could be scaled back. My impression is that residency is actually where doctors really learn most of what they'll use in everyday practice for the rest of their lives. I would think that if any part of the medical education process could be pared back, it would be the clinical years of med school. Do I really need to spend weeks upon weeks staying up all night learning how to deliver babies, or sew lacerations, if I'm going to become, say, a radiologist or pathologist?

3. The money issue is what worries me the most. People are saying it's OK to get paid peanuts as a resident, because when you're done, you're going to make $200K+ in private practice. First, that's only the case in some specialties. More importantly: not for long, if the Hillary Clintons of the nation have their way, and I recognize I'm overly pessimistic, but I feel it's not long before they do. Just wait until Congress caps doctors' income, like Canada does. I feel our society is approaching a critical mass of people who believe that doctors are evil, greedy, arrogant, selfish snobs who bleed the families of poor little girls dying of cancer dry so they can drive their Benz to the country club and spend all their time playing golf. Thus, the masses are going to be sympathetic to steps toward socialized medicine. The best we can hope for is that we'll get a system more like the UK's, where docs CAN see patients on a fee-for-service basis outside of the government plan. Even so, it's going to be tough to pay back $200k in loan debt. So the government, having recognized the problem its "solution" to the "health care crisis" created in driving people out of medicine, will of course feel obliged to provide another "solution": paying for medical education. This will be just another step in the vicious circle leading to fully socialized medicine.

But that's a rant for another day. 😀

 

[hakksar]

I agree with your argument, but also don't forget that for people going into science faculty positions, the PhD is only the beginning. At least in biology and chemistry, one also has to do at least one postdoc in order to be able to apply for academic jobs, so that's another ~4 years of "training." Postdocs in biology get paid a bit less than medical residents. It's interesting because the total training time after college is about the same for science and medicine (7-10yrs for medicine, 8-10 for science), but scientists don't accumulate debt along the way, and then get paid quite a bit less once in their "career" stages. (Starting salaries for assistant professors in biology range from $45k-75k.)

I agree completely (ironically Post-docs make roughly the same as a medical resident . . . in the lab I work in they make almost exactly the same as Residents here at CU . . . but it all depends on lab funding). I feel that post-docs are very underpaid in that although they are still in "training" they come out of a post-doc with no more than experience and a good LOR for their first job (no board certification or other credentials).

 

[AlternateSome1]

If money means that much to you go to Law School. We need less premeds obsessed over money.

Money doesn't have to be an obsession for it to mean SOMETHING to a person. The way I see it, anyone in med school who wants to start a family is really going to be feeling their biological clock ticking by the time school is up. Instead of being able to jump into a decent lifestyle of some sort, we are forced to sacrifice even more time for training while not even getting paid enough to payback loans, and not getting paid enough to make up for the amount of time away from your spouse/family. I don't think $37,000 is a small amount of money, but when you are working 80-100 hours a week it is nothing. If I wanted to make $6.00-7.00 an hour, I would go work at McDonalds without 8 years of postsecondary education and without a $150,000 debt. Lifestyle is becoming a pretty big issue with medical students anymore, which you can see by the people flocking to residencies like derm, gas, rads, path, and optho. The idea that people should just suck it up and deal with the harsh residency or go to law school is what is making the best and brightest run off to fight acne and run from the old-school residencies like IM and General Surgery. Maybe you want to sacrifice your entire life to medicine, but why should others have to? If residency programs were cut down to 50 hours per week and allowed moonlighting time to be uncounted, the people who wanted to work all the time could and the ones who wanted to have a life outside of their job could. As the system stands, I for one will not be changing my dreams and going to law school, but you can bet I will not be going for IM.

 

[doctorbeans]

I can't believe how much everyone is bitching about this!

It *IS* a stipend and it *IS* school. You may be working, but you're still learning. You might have an MD hanging on your wall but it doesn't mean ****, because when you graduate you don't know crap compared to what you know when you finish residency. Someone who wants to be a surgeon learns practically EVERYTHING during their residency. So come on people....

Jeez. I had thought that the prevalence of money grubbers in medicine had decreased (b/c medicine doesn't pay as well as it used to), but I guess I was wrong. I am ashamed to have some of you as my colleagues.

Residency will be difficult, and money will be tight, but MUCH less tight than it was before. So quit your bitching, as an MD, you are not going to be the be all end all. So stop telling yourself you can even BE a martyr. When you die for the sake of a patient, I will call you a martyr. Until then, you will just be an underpaid intellectual who only has to put up with it a few years and then be grossly overpaid.

Think of all the industries where people have to do UNPAID internships, and then get paid much less than when they work: ie Student Teachers.

 

[Rogue_Leader]

Other professions do have it tough, but I think the main point is that residents get the worst of both worlds. They get a very low salary and they're expected to work a large number of hours a week, sometimes pushing 100 hours a week. On top of that, medical school leads to large amounts of debt. Plus, by the time they're done with their residency, they're in their early to mid thirties. What other profession has so many things working against it? Why do residents deserve to be screwed on all four fronts?

 

[redstorm]

I love these "you have no right to talk about money if you want to be a doctor" statements. Here's a piece of advice: Money is part of everything you do, you need it to survive, you need it to live, you need it to start and support a family, you even need it when you die. Nobody should be a slave to money, but you need to get over it and accept the fact that it's not going away. Nor should you criticize those who want to examine and debate every facet of a career choice. I respect your right to live in some third world country dispensing medical help to those who can't afford it, however, you should respect those people who choose to practice medicine with the hope of living comfortably and wanting to raise a family.

-J[/QUOTE]
Hey i agree with you jeff.. Onestrongbro is prob a premed and has no idea what he is talking about.. When it comes down to it.. We live in the United States of America a capitalistic society which is the finest system in the world. Medicine is a business. If the doctors dont make the money, someone will which is usually the head of the HMO or the hospital administrator.. You are the product, so YOu should make the money.. It doesnt make you a worse doctor for wanting more money. DOctors have sacrificed and they should make all the profits.....

 

[Jeff3614]

I don't mean to kick this horse again, but I couldn't resist commenting on doctorbeans - shall we say - shallow-minded post.


Okay, on to business.



Doctorbeans,

I can't believe how much everyone is bitching about this!

If you had read this thread you'd realize a majority of people aren't bitching, but trying to understand the motivations behind hospitals paying residents a nominal salary.

It *IS* a stipend and it *IS* school. You may be working, but you're still learning.

I submit to you this definition of the word "Stipend", which you seem to think means something different than everyone else.

From the Merriam-Webster online dictionary:

Main Entry: sti?pend
Pronunciation: 'stI-"pend, -p&nd
Function: noun
Etymology: Middle English, alteration of stipendy, from Latin stipendium, from stip-, stips gift + pendere to weigh, pay : a fixed sum of money paid periodically for services or to defray expenses

Main Entry: sal?a?ry
Pronunciation: 'sal-rE, 'sa-l&-
Function: noun
Inflected Form(s): plural -ries
Etymology: Middle English salarie, from Latin salarium pension, salary, from neuter of salarius of salt, from sal salt -- more at SALT
: fixed compensation paid regularly for services


WOW, both of these terms seem eerily alike, don't they? Further, every profession has thier 'scutwork years' and consequently these 'scutwork years' are the learning phase of every profession. The difference between you and the garbage man is that the garbage man will enter into a job market in which the prospective companies are required to compete for the best personal, whereas hospitals don't have to compete for the best residents by luring them with better pay.

You might have an MD hanging on your wall but it doesn't mean ****, because when you graduate you don't know crap compared to what you know when you finish residency. Someone who wants to be a surgeon learns practically EVERYTHING during their residency. So come on people....

Reread the thread. I don't recall any poster claiming that residents were high on thier credentials, and thus required more money because they "have an MD hanging on thier wall."

Jeez. I had thought that the prevalence of money grubbers in medicine had decreased (b/c medicine doesn't pay as well as it used to), but I guess I was wrong. I am ashamed to have some of you as my colleagues.

Please remember this when you walk into the Mercedes or BMW dealship to buy a car - because you just wanted a dependable automobile, right? If we wanted a cock and bull story, we'd read Hemingway. (Yes, a Simpsons rippoff!)

Residency will be difficult, and money will be tight, but MUCH less tight than it was before. So quit your bitching, as an MD, you are not going to be the be all end all. So stop telling yourself you can even BE a martyr. When you die for the sake of a patient, I will call you a martyr.

Huh?

Read: Context.

Until then, you will just be an underpaid intellectual who only has to put up with it a few years and then be grossly overpaid. Think of all the industries where people have to do UNPAID internships, and then get paid much less than when they work: ie Student Teachers.

Umm, just because you drank the coolaid with a smile on your face doesn't mean the rest of us have too. I happen to agree that other professions are grossly underpaid for the work they do, however, we are talking about residencies, not student teaching. What does that have to do with the price of rice in China?

-J

 

[susannaQ]

Because medical education is a human-built system and, like all other systems, have flaws in them and aren't built to accomadate everyone's needs, wants, and capabilites.

I am upset over the long-hour residencies I hear about too. But, the word is around that people(dont ask me what people) are trying to change this for the sake of patient safety and just general morality(is it really right to ask someone to worth THAT much and give that much of their life and be happy with a simple living stipend?)

How I deal with it: Medicine is a social institution like all the rest of them and in order to get into it and have your place, youre just going to have to go through a lot of what you think is unecessary bull**** and follow rules set for the majority just like you have done throughout your entire life until now when you had to go to kindergarden, then elementary, the high, then college and when youve payed whatever someone else told u u had to pay and worked around someone's else's schedule: thats how the world works. no exceptions for you: the good thing is that we're all used to this, we just have to suck it up and keep on being used to this and try to not to work against something we cant overcome...