Why don't medical doctors have to pay to go to residency?

[str8ner]

It occurred to me that while many dentists pay handsomely to go to residency, medical doctors (to the best of my knowledge) do not. Why is this?

The general reasoning as to why dental residencies charge tuition is because they can. There is no shortage of dentists trying to get into residency programs and they seem to always be able to get the student loans no matter how high the tuition.

Why then is this not the case for medical residencies and what can the dental profession learn from this? Some may say that medical residencies are attached to hospitals and therefore get GME funding. My orthodontic residency was attached to a hospital and I got GME funding ( Yes, I feel very lucky that I matched to a program that pays.). However, there are many private school residencies that charge shockingly high tuition. Despite the high tuition there is no shortage of applicants to these programs.

I assume there is no shortage of people trying to get into popular medical residencies. Why are there no private residency programs starting up to to take advantage of the opportunity to charge $100K+ per year in tuition? Is there an accreditation rule that prevents this from happening? If so could CODA apply the same rules to dental education?

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[vellnueve]

Because people aren’t going to pay for the privilege of working in house 80-100 hours a week on top of the study time at home, and because dental residencies by and large do not sustain themselves financially

 

[Pennywisdom]

In addition to what's said above, medical necessities are more of a priority than any dental necessities, and therefore it makes no sense to provide government funding for those dental residents who don't take call and take care of patients. There's no doubt that, for instance, a cardiology resident is just more valuable in a HOSPITAL setting than a say a periodontal resident. Plus, there's nothing emergent in dentistry that can't be handled by most GPRs, OMFS, and Pediatric dental residents.

 

[Likkriue]

dental residencies outside of peds gpr and OMFS are basically treated like masters programs/certs. You spend 3 years and pay 3 extra years of dental school to work for them.

 

[Firm]

Dentistry should be a 6 year program out of high school with a minimum 2 year residency for general. 4-8 for everything else.

 

[Mad Jack]

Because Medicare funds residencies to provide physicians that will, more often than not, ultimately provide care for Medicare patients. Even if they don't, during training they help Medicare-accepting hospitals continue to operate. Dentists don't really do a lot of Medicare work.

 

[GypsyHummus]

Dentists don't really do a lot of Medicare work.

Is that why dentists can work 3 days a week and still pull in 300k? Because they get reimbursed for the procedures that they do?

 

[Mad Jack]

Is that why dentists can work 3 days a week and still pull in 300k? Because they get reimbursed for the procedures that they do?

Different issue, but related

 

[PhansterZ]

Is that why dentists can work 3 days a week and still pull in 300k? Because they get reimbursed for the procedures that they do?

This is off-topic, but I will chime in.

Dentists can be reimbursed by either cash (fee for service), private insurance (HMO, PPO) or government insurance (Medicaid, Medicare).
In terms of reimbursements, from highest to lowest is usually FFS > PPO> HMO > Medicare = Medicaid.
While you can charge full price for FFS patients, PPO's and HMO's can negotiate with you to 50-90% of your prices, while Medicaid/Medicare can pay from 20-50% of what you charge, and in some cases, not even cover the procedure.

When you are a new dentist, you will take every insurance known to man, as keeping your schedule busy and making some money is better than sitting in your office twiddling your thumbs. As you build up new your practice, you will soon stop taking low paying insurance and focus on the FFS and high paying insurance. Medicaid and Medicare are usually the first insurances to be cut because of this.

My uncle had a decayed tooth and was on Medicaid. Oral surgeons in my town wanted $300 to take the tooth out. Medicaid wanted to pay $75. Guess how many oral surgeons in my town took Medicaid? 1 out of 10. He was hurting in July, and the "next available appointment".... December.

 

[TN123]

It occurred to me that while many dentists pay handsomely to go to residency, medical doctors (to the best of my knowledge) do not. Why is this?

The general reasoning as to why dental residencies charge tuition is because they can. There is no shortage of dentists trying to get into residency programs and they seem to always be able to get the student loans no matter how high the tuition.

Why then is this not the case for medical residencies and what can the dental profession learn from this? Some may say that medical residencies are attached to hospitals and therefore get GME funding. My orthodontic residency was attached to a hospital and I got GME funding ( Yes, I feel very lucky that I matched to a program that pays.). However, there are many private school residencies that charge shockingly high tuition. Despite the high tuition there is no shortage of applicants to these programs.

I assume there is no shortage of people trying to get into popular medical residencies. Why are there no private residency programs starting up to to take advantage of the opportunity to charge $100K+ per year in tuition? Is there an accreditation rule that prevents this from happening? If so could CODA apply the same rules to dental education?

 

[TN123]

Please look up GME

 

[el_duderino]

As mentioned, but more directly, medical residency positions are funded by the US government. The salary a medical resident makes is a portion (half or so) of the money paid to the hospital by the government to have the resident.

 

[Mad Jack]

you should really talk to dentist in California. Most private dental office see Medicare; what else can you do when majority of people reply on Medicare for everything. I still gladly see Medicare patient than HMO. HMO pay 5$ a filling or 40$ for a crown is an insulting to the dentistry profession as a whole. Cannot believe the ADA let HMO degrade us with those fee schedule.

That's truly embarrassing

 

[oralcare123]

This is off-topic, but I will chime in.

Dentists can be reimbursed by either cash (fee for service), private insurance (HMO, PPO) or government insurance (Medicaid, Medicare).
In terms of reimbursements, from highest to lowest is usually FFS > PPO> HMO > Medicare = Medicaid.
While you can charge full price for FFS patients, PPO's and HMO's can negotiate with you to 50-90% of your prices, while Medicaid/Medicare can pay from 20-50% of what you charge, and in some cases, not even cover the procedure.

When you are a new dentist, you will take every insurance known to man, as keeping your schedule busy and making some money is better than sitting in your office twiddling your thumbs. As you build up new your practice, you will soon stop taking low paying insurance and focus on the FFS and high paying insurance. Medicaid and Medicare are usually the first insurances to be cut because of this.

My uncle had a decayed tooth and was on Medicaid. Oral surgeons in my town wanted $300 to take the tooth out. Medicaid wanted to pay $75. Guess how many oral surgeons in my town took Medicaid? 1 out of 10. He was hurting in July, and the "next available appointment".... December.

you should really talk to dentist in California. Most private dental office see Medicare; what else can you do when majority of people reply on Medicare for everything. I still gladly see Medicare patient than HMO. HMO pay 5$ a filling or 40$ for a crown is an insulting to the dentistry profession as a whole. Cannot believe the ADA let HMO degrade us with those fee schedule.

Not every HMO in California pays like that. $50 for a one surface filling and $250 for a crown

 

[oralcare123]

If you own a private office, of course you can chose what HMO to accept or not. But when you work for someone else or other corporation, you will have to work for whatever insurance the owner accepts. Those 5$ a filling and 40$ a crown are the fee schedule for some of the garbage HMO that we accept. It is downright humiliating to work for that price.

I understand, just didn't want the impression to be that all HMO ever pays is what you said. At the same time owner gets per capita pay, which might be significant. Often patients are offered over treatment and upsaled items like irrigation of pockets for $300 during regular cleaning or porcelain edge upgrade at $150 for a PFM crown on a lower posterior crown. Refusal to upgrade or irrigate causes you to be kicked out of the practice. Haven't met a suffering dentist yet

 

[siliso]

Why do physicians have to treat people regardless of whether they have any money and dentists can tell them GTFO? We’ve all got problems, man.

 

[deleted103644]

It occurred to me that while many dentists pay handsomely to go to residency, medical doctors (to the best of my knowledge) do not. Why is this?

The general reasoning as to why dental residencies charge tuition is because they can. There is no shortage of dentists trying to get into residency programs and they seem to always be able to get the student loans no matter how high the tuition.

Why then is this not the case for medical residencies and what can the dental profession learn from this? Some may say that medical residencies are attached to hospitals and therefore get GME funding. My orthodontic residency was attached to a hospital and I got GME funding ( Yes, I feel very lucky that I matched to a program that pays.). However, there are many private school residencies that charge shockingly high tuition. Despite the high tuition there is no shortage of applicants to these programs.

I assume there is no shortage of people trying to get into popular medical residencies. Why are there no private residency programs starting up to to take advantage of the opportunity to charge $100K+ per year in tuition? Is there an accreditation rule that prevents this from happening? If so could CODA apply the same rules to dental education?

As many people have already informed you, the answer is CMS providing funding for GME, usually to the tune of $150k per resident per year * number of years in initially matched residency (second residencies and fellows reimbursed at half that).

About half of that goes to resident salaries and benefits, the other half goes to “education”.

Some larger programs take more residents than they have approved spots for funding, so they pay out of pocket for them.

Previously, physicians did pay for their own residencies sometimes (or worked for free), and training was usually much shorter.