Why do we pay tuition for rotations?

[Mysterio123]

Hi,

I was told by a friend 5 years ago that paying tuition during rotations was like paying the school to work FOR the school. Soon I'll be in my friend's position and was wondering why the system is like this?

Is there a way to reform this? Protest? So rotation years are FREE? I'm not asking to be paid when an M3, just that tuition becomes FREE.

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[curbsideconsult]

Because we are still learning (a LOT) during rotations. The amount of times I've been helpful to any service compared to how many times I'm more in the way than anything is probably a ratio of 1:1569 (I'm exaggerating, but you get the picture). Plus they have to pay for that malpractice insurance when, inevitably, we students eff up. We are basically walking, talking liabilities. Maybe if all M3s were PAs or RNs prior to med school then we can entertain the idea that tuition should at least be discounted, but most M3s are straight out of college with no such experience.

 

[Winged Scapula]

While I can come up with reasons, I have to admit that as adjunct faculty for an osteopathic school, I object to the ginormous tuition the students pay during their 4th year for rotations they often set up, with preceptors that are paid (unless they refuse compensation as I do) about $400/student/month.

 

[futuremdforme]

I think it's silly and would prefer a system of lower tuition, small salary during rotations, and lower salary as staff than the current system. The real reason is because they can get away with it.

 

[siliso]

Cause you’re a lot more work for than help to your faculty and staff. Sorry but true - we love teaching you anyway. You’ll get paid (some) to learn how to become useful once you’ve got a degree and license.

 

[Mad Jack]

I think it's silly and would prefer a system of lower tuition, small salary during rotations, and lower salary as staff than the current system. The real reason is because they can get away with it.

Why do you think medical students deserve a salary during rotations? They provide nothing of value and are more in the way than anything.

As to the reason you pay during rotations, it is really just cost averaging, as the first two years cost much more than the last two, but they smooth out costs over the four years.

 

[siliso]

I don’t even know if it’s true that the last two years are lest costly to the school. Having their own phds talk in lecture halls they own to all the students of a class at once obv requires resources but is pretty simple to organize by comparison. Organizing clinical experiences (along with the didactics) that meet LCME requirements for all x-hundred students in all required areas is a huge undertaking.

 

[futuremdforme]

Why do you think medical students deserve a salary during rotations? They provide nothing of value and are more in the way than anything.

As to the reason you pay during rotations, it is really just cost averaging, as the first two years cost much more than the last two, but they smooth out costs over the four years.

Clinical rotations are on the job training, and most work pays for that. If you're doing 60 hr weeks with 26 hr shifts, and no flexibility, it seems unfair to pay for that privilege. I would say that my value probably ends up neutral -- I've definitely been useful on some rotations but I definitely appreciate that I've slowed things down a LOT on others.

 

[siliso]

You’re not on the job as a medical student, you’re a learner. You’re not even legally permitted to do the job, at all. Whatever you do re patient care must be directly observed or redone by someone with a medical license. When you are not there, the people with the licenses to do the job can do it faster and easier than when you are there. That’s not to make you feel bad - clinical instructors generally like teaching you despite that and if they didn’t they’d go work faster for more money elsewhere.

The paid on the job training is your residency.

 

[NontradICUdoc]

Because you are still a student. You are not hired by the hospital or the residency program, you cannot bill, and you are still a student. Should tuition be lowered, yes. But you should certiainly NOT get paid because this is not on the job training.

 

[Wordead]

I dont really get this logic. You think it should cost more to sit in a lecture hall while some phd babbles on than for you to come into the hospital, see patients, scrub into surgeries, etc?

I agree med school costs need to be controlled but good lord the optimization should be preclinical not clinical

 

[NITRAS]

Clinical rotations are on the job training, and most work pays for that. If you're doing 60 hr weeks with 26 hr shifts, and no flexibility, it seems unfair to pay for that privilege. I would say that my value probably ends up neutral -- I've definitely been useful on some rotations but I definitely appreciate that I've slowed things down a LOT on others.

You are confusing work with economic value.

Medical student and resident work is non-billable without a supervising physician. Residents provide value in that they provide coverage, but it provides non-billable work. Supervising students and residents is a lot more tetious than you’d believe.

 

[siliso]

Residents can also do actual work under my supervision that lightens my load compared to working without residents (I don’t have to put the orders or answer the pages, though I am available to approve of or refine the plan and help with decisionmaking on what should be done about the pages). When a medical student can take care of the people over the night or during the day while I’m doing other things, paging/texting me as needed for guidance, maybe you have an argument. But they can’t and shouldn’t. You’re not working as a medical student, you’re in school. It feels like work but in fact is not. Doing one H&P on a call day under direct supervision or the resident and staff is a learning exercise, not RVU production. Take advantage of this while you can - spending your time learning and getting to know patients without any pressure to produce - and flexibility is more than you think. If the med student needs to dip for lecture or for a personal appointment or anything, it’s no skin off anyone’s nose, so do it within reason.

 

[QueenJames]

CREAM... GET THE MONEY.

DOLLER DOLLAR BILL YOU ALL.

 

[BorntobeDO?]

CREAM... GET THE MONEY.

DOLLER DOLLAR BILL YOU ALL.

More money more problems, my man.

 

[FrkyBgStok]

Clinical rotations are on the job training, and most work pays for that. If you're doing 60 hr weeks with 26 hr shifts, and no flexibility, it seems unfair to pay for that privilege. I would say that my value probably ends up neutral -- I've definitely been useful on some rotations but I definitely appreciate that I've slowed things down a LOT on others.

Neutral? Med students are helpful with scut work and non-crucial tasks but I think you are overestimating your value as a med student. In fact, in all 3 years of residency, I can count on zero hands the number of times I have thought, “wow this med student was really helpful.” And that’s ok because you are there to learn about the specialty.

And you shouldn’t be helpful. If, as a senior, I let the med student run the service while I sleep at night, that would be helpful but incredibly dangerous. So no one would ever do that.

And those times that you did compressions weren’t truly helpful. We let you rotate in to feel helpful but a nurse was standing right over there and would have taken your spot If you weren’t there. You should pay for the 3rd and 4th year.

 

[Dave1980]

I remember at least one rotation where I was a net positive.

I didn't show up for the rotation because there was no oversight and no on cared and then brought bagels on my last day.

 

[Giovanotto]

I'm pretty sure most of my faculty could pistol whip me and I'd largely have no recourse. That's why. Anyone trying to run a numbers game about how there is a good financial reason is either delusional or worse, complicit. It doesn't cost 50k a year to have me set up and pay for my own rotations via VSAS for the majority of MS4. It just doesn't. And what's this business about cost averaging over 4 years? Just LOL!

 

[futuremdforme]

Neutral? Med students are helpful with scut work and non-crucial tasks but I think you are overestimating your value as a med student. In fact, in all 3 years of residency, I can count on zero hands the number of times I have thought, “wow this med student was really helpful.” And that’s ok because you are there to learn about the specialty.

And you shouldn’t be helpful. If, as a senior, I let the med student run the service while I sleep at night, that would be helpful but incredibly dangerous. So no one would ever do that.

And those times that you did compressions weren’t truly helpful. We let you rotate in to feel helpful but a nurse was standing right over there and would have taken your spot If you weren’t there. You should pay for the 3rd and 4th year.

I have specifically been told that I was more useful than off-service residents.

Amazingly I have never done compressions, but if you would just have a nurse instead... well that nurse is getting paid.

Anyway you can get off your high horse because I already pointed out that my opinion doesn't matter since nothing's going to change.

 

[FrkyBgStok]

I have specifically been told that I was more useful than off-service residents.

Amazingly I have never done compressions, but if you would just have a nurse instead... well that nurse is getting paid.

Anyway you can get off your high horse because I already pointed out that my opinion doesn't matter since nothing's going to change.

I think you are misinterpreting a high horse and a reality check. In no way am I portraying that I am better than medical students. I obviously was one, once. I would argue that you should get off your high horse thinking that you as a medical student are so invaluable to medical system that you should be paid for your presence rotating through all the specialties. In addition, you aren’t unique with clinical rotations. Nurses, PCTs, CNAs, X-ray techs, everyone in the medical field does clinic rotations. So get off your high horse thinking that you are so much more special than everyone else. You aren’t getting on the job training. That’s residency.

You are right that nothing is going to change but the attitude that you are special or that your job is so much more important and elite than the others in the healthcare field is going to get you in trouble.

 

[futuremdforme]

You are right that nothing is going to change but the attitude that you are special or that your job is so much more important and elite than the others in the healthcare field is going to get you in trouble.

I wish that they got paid for their on-the-job training too. I have found student nurses super helpful - they definitely contributed to the team. I don't think I'm special, or that med students are special. I just have socialist leanings, that's all.