Why don't Residents make as much as PAs?

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This has been discussed ad nauseum in other threads. Residents are still in training and many are not at the point where they are ready to lead a healthcare team at the same standards as an attending. If you want to skip residency and open your own practice, you can do that and will probably make around as much as many PA's. If you want to make the big bucks then you should attend residencies which are largely reimbursed through medicare/medicaid and other government sources so you can eventually be reimbursed by those entities and insurance companies, which will pay far better than most individuals will who see non-residency trained GPs.
 
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Thank you for coming up with that list @Mad Jack. I had read some of those threads, and will finish up with the rest. I created this thread because I thought, maybe (probably?) erroneously, that it was an ongoing issue.


http://forums.studentdoctor.net/threads/resident-pay-seems-unfair.810183/page-2

""Yes.

Several decades ago 'resident' was mostly another word for interns, because that's all the training that the vast majority of physicians went through. Maybe a few top surgeons might do a second year, but by in large your year as a resident was a short process of hazing that forced physicians to make the transition from medical student to practicioner in a very short amount of time. Also keep in mind this was back when any path other than HS ->college --> medical school without a break was basically unheard of, and student debt was typically much less. For an almost invariably single, male, 26 year old physician with very little debt a year or two of poverty was no disaster.

Also, decades ago, there was nothing 'unfair' about not paying residents a living wage, since the vast majority of them weren't actually profitable employees. They were no different than Interns today: in need of constant supervision. They were in no way capable of increasing the size of the census list since the attending would still need to carry every patient in the hospital as though he was working alone. I'm pretty sure they also didn't bring federal funding to the hospital (could be wrong on that one, though). Hospitals paid the young docs the nothing that they were worth.

Fast forward to today: Residency began it's slow expansion several decades ago and now is anywhere between 3 and an insane number of years. Take, for example, a Peds CT surgeon. He starts medical school at the average age of 24, then has 4 years of medical school --> 5 years of a surgical residency (and maybe a research year or two) --> 3 years Peds Surgery fellowship --> 2 years Peds CT surgery fellowship before he can even start on the bottom rung of a practice. By the third year of his 10+ years of residency training he is running rooms and managing floors almost without supervision and is therefore paying for several times his own salary by increasing the number of patients the attending can 'carry'. Furthermore for this entire time he fundeded by the federal government to the tune of 100k/year, so even if he didn't see a single patient the hospital would still make a profit on him. He's also probably drowing in, what since 2003, is non dischargable debt.

The push-back from residents that has led to improved work hours and something approaching a living wage came about when residents began to realize that residency had morphed from a short period of training, in which they were getting a good financial deal by being paid at all, into a very long period of employment, where residents are working for less than the wages they deserve because they're employed by an organization that anti-trust laws don't apply to. I'm glad it's gotten better, but if we're going to keep residencies as they are then we have a long way to go.""

-This seems to sum it up quite well. We're getting screwed, what a shocking surprise.
 
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Mad Jack said:
When will premeds learn to use the search function?
Should they?
Can they?
Will they ever?

http://forums.studentdoctor.net/threads/why-do-residents-get-paid-so-little.884240/
http://forums.studentdoctor.net/threads/why-do-residents-make-so-little.1068298/
http://forums.studentdoctor.net/thr...id-so-little-and-have-to-work-so-hard.134712/
http://forums.studentdoctor.net/threads/nurse-pay-vs-resident-pay.715648/
http://forums.studentdoctor.net/threads/is-a-residents-salary-too-high-too-low-or-just-right.722149/
http://forums.studentdoctor.net/threads/resident-pay-seems-unfair.810183/
http://forums.studentdoctor.net/threads/nurses-making-more-than-residents.1143912/

Etc etc... The last thread is probably the most thorough discussion of this. We're not doing it again. Nope. Sorry. Not gonna.
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Thanks...those were really interesting reads!
 
Giovanotto said:
Thank you for coming up with that list @Mad Jack. I had read some of those threads, and will finish up with the rest. I created this thread because I thought, maybe (probably?) erroneously, that it was an ongoing issue.


http://forums.studentdoctor.net/threads/resident-pay-seems-unfair.810183/page-2

""Yes.

Several decades ago 'resident' was mostly another word for interns, because that's all the training that the vast majority of physicians went through. Maybe a few top surgeons might do a second year, but by in large your year as a resident was a short process of hazing that forced physicians to make the transition from medical student to practicioner in a very short amount of time. Also keep in mind this was back when any path other than HS ->college --> medical school without a break was basically unheard of, and student debt was typically much less. For an almost invariably single, male, 26 year old physician with very little debt a year or two of poverty was no disaster.

Also, decades ago, there was nothing 'unfair' about not paying residents a living wage, since the vast majority of them weren't actually profitable employees. They were no different than Interns today: in need of constant supervision. They were in no way capable of increasing the size of the census list since the attending would still need to carry every patient in the hospital as though he was working alone. I'm pretty sure they also didn't bring federal funding to the hospital (could be wrong on that one, though). Hospitals paid the young docs the nothing that they were worth.

Fast forward to today: Residency began it's slow expansion several decades ago and now is anywhere between 3 and an insane number of years. Take, for example, a Peds CT surgeon. He starts medical school at the average age of 24, then has 4 years of medical school --> 5 years of a surgical residency (and maybe a research year or two) --> 3 years Peds Surgery fellowship --> 2 years Peds CT surgery fellowship before he can even start on the bottom rung of a practice. By the third year of his 10+ years of residency training he is running rooms and managing floors almost without supervision and is therefore paying for several times his own salary by increasing the number of patients the attending can 'carry'. Furthermore for this entire time he fundeded by the federal government to the tune of 100k/year, so even if he didn't see a single patient the hospital would still make a profit on him. He's also probably drowing in, what since 2003, is non dischargable debt.

The push-back from residents that has led to improved work hours and something approaching a living wage came about when residents began to realize that residency had morphed from a short period of training, in which they were getting a good financial deal by being paid at all, into a very long period of employment, where residents are working for less than the wages they deserve because they're employed by an organization that anti-trust laws don't apply to. I'm glad it's gotten better, but if we're going to keep residencies as they are then we have a long way to go.""

-This seems to sum it up quite well. We're getting screwed, what a shocking surprise.
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"Several decades ago" probably refers back to a time (50+ years ago) before much of the medications and imaging we have now, and even then it was an exaggeration to say only surgeons did a second year of residency.

You aren't getting screwed, you are training. The value you add as a resident is minimal -- you slow attendings down mostly. You aren't profitable employees until late in your training, and at that point you become less valuable as an employee precisely because you are likely to leave in a year (unlike your mid level counterpart.).
 
Law2Doc said:
"Several decades ago" probably refers back to a time (50+ years ago) before much of the medications and imaging we have now, and even then it was an exaggeration to say only surgeons did a second year of residency.

You aren't getting screwed, you are training. The value you add as a resident is minimal -- you slow attendings down mostly. You aren't profitable employees until late in your training, and at that point you become less valuable as an employee precisely because you are likely to leave in a year (unlike your mid level counterpart.).
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Yeah, it was also a time when we had all of a dozen medications to learn and most of medicine still consisted of shrugs and I dunnos when people asked wtf was wrong with them or what we could do to help them. Residency is longer because the amount if knowledge we need to know has increased literally a hundred fold since then, if not much, much more.
 
Law2Doc said:
"Several decades ago" probably refers back to a time (50+ years ago) before much of the medications and imaging we have now, and even then it was an exaggeration to say only surgeons did a second year of residency.

You aren't getting screwed, you are training. The value you add as a resident is minimal -- you slow attendings down mostly. You aren't profitable employees until late in your training, and at that point you become less valuable as an employee precisely because you are likely to leave in a year (unlike your mid level counterpart.).
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Just to play devil's advocate, in my mostly outpatient specialty, residents keep the clinic going. That's not to say an attending couldn't personally see more patients per hour than me, but usually one attending is supervising 3-4 residents per clinic. At 3-4 patients an hour, the attending is effectively "seeing" upwards of 15-16 patients per hour, a feat not possible on their own. Residents have 100% continuity clinic. Attendings see their own patients usually 2-4 half days a week, at a clip of 3 or 4 patients per hour.
 
Law2Doc said:
"Several decades ago" probably refers back to a time (50+ years ago) before much of the medications and imaging we have now, and even then it was an exaggeration to say only surgeons did a second year of residency.

You aren't getting screwed, you are training. The value you add as a resident is minimal -- you slow attendings down mostly. You aren't profitable employees until late in your training, and at that point you become less valuable as an employee precisely because you are likely to leave in a year (unlike your mid level counterpart.).
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Really the value residents add is minimal? That's a bit ridiculous. In academic settings residents are doing most of the attendings work for them. We run the hospitals 24/7..I don't see many attendings cross covering nights. Some attendings even refuse to do bedside procedures like LPs, para's, line placements and instead dump it on the residents in the name of training and no many don't even bother to supervise. I have yet to see an attending do any bedside procedure.

If residents didn't add value you wouldn't see program leaders in many of the already saturated fields trying to add even more years of training or more residency spots despite already over training if it was hurting their bottom line (just look at the over training and the effects it has had at the detriment of the trainee in radiology, rad onc, pathology, anesthesiology, etc, many have to do further training just to keep a salary because the job market is so over saturated)..paying these residents and fellows a fraction of the cost of an attendings salary to run the hospital clearly benefits hospital administration which is why now midlevels are getting so much leeway because they too can do the work at the fraction of the cost of an MD attending. Trainees are clearly adding value for hospital administration in more ways than one..
 
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Law2Doc said:
"Several decades ago" probably refers back to a time (50+ years ago) before much of the medications and imaging we have now, and even then it was an exaggeration to say only surgeons did a second year of residency.

You aren't getting screwed, you are training. The value you add as a resident is minimal -- you slow attendings down mostly. You aren't profitable employees until late in your training, and at that point you become less valuable as an employee precisely because you are likely to leave in a year (unlike your mid level counterpart.).
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Most of that applies to new PAs as well. What it comes down to is they pay poorly because they can as residents have to go through the process to be able to practice independently and make real money. Go through the process now and remember that and never feel bad about(ethically) maximizing your income as an attending.
 
Mad Jack said:
Yeah, it was also a time when we had all of a dozen medications to learn and most of medicine still consisted of shrugs and I dunnos when people asked wtf was wrong with them or what we could do to help them. Residency is longer because the amount if knowledge we need to know has increased literally a hundred fold since then, if not much, much more.
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So then by this logic, what to do we do next? Do we keep extending residencies (as the body of knowledge grows) and keep paying peanuts? I seriously can't follow this reasoning. I'm also pretty sure that after a few months (2-6?) of training a resident can carry out bread and butter procedures with minimal supervision. Isn't 90% of medicine repetitive anyways?

What I'm saying is that I can see why interns are paid peanuts (it' peanuts, lets not argue about this), since they are learning that particular hospital's emr and other nuances, but after that, I don't understand.
 
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Giovanotto said:
So then by this logic, what to do we do next? Do we keep extending residencies (as the body of knowledge grows) and keep paying peanuts? I seriously can't follow this reasoning. I'm also pretty sure that after a few months (2-6?) of training a resident can carry out bread and butter procedures with minimal supervision. Isn't 90% of medicine repetitive anyways?

What I'm saying is that I can see why interns are paid peanuts (it' peanuts, lets not argue about this), since they are learning that particular hospital's emr and other nuances, but after that, I don't understand.
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Feel free to copy and paste any number of responses from myself and others in prior threads. There's some great economic papers out there on it, all of which are in those prior threads.
 
I could run my OR more efficiently and almost certainly more easily and certainly safer without any residents. They're not adding any value to my practice. Many private hospitals function just fine without any trainees around "doing all the work" for the lazy attendings. If residents were the great windfall you seem to believe that they are, every garbage hospital with any volume would be opening training programs. You could argue that that's what they did with SRNA programs, but they are being paid to go there and they are staffed by CRNAs anyway, so that's a win economically. That was common in the area where I used to work. The poor quality product pushed out the doors is someone else's problem. They'd never hire them back.


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Il Destriero
 
IlDestriero said:
I could run my OR more efficiently and almost certainly more easily and certainly safer without any residents. They're not adding any value to my practice. Many private hospitals function just fine without any trainees around "doing all the work" for the lazy attendings. If residents were the great windfall you seem to believe that they are, every garbage hospital with any volume would be opening training programs. You could argue that that's what they did with SRNA programs, but they are being paid to go there and they are staffed by CRNAs anyway, so that's a win economically. That was common in the area where I used to work. The poor quality product pushed out the doors is someone else's problem. They'd never hire them back.


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Il Destriero
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Are you also saying then that residents are less capable than midlevels? Or are you saying you can run the entire OR yourself?
 
Giovanotto said:
Are you also saying then that residents are less capable than midlevels? Or are you saying you can run the entire OR yourself?
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Residents are not doing the same job as midlevels, and are also being trained constantly, unlike midlevels. An NP doesn't require weekly didactics, on-call rooms, an entire academic department and infrastructure, etc. NPs only add resources while requiring nothing else in return. Residents decrease attending efficiency, increase hospital resource use, and generally require a lot of upkeep- they give but they take. It is, quite frankly, a stupid comparison.
 
Residents can make PA wages by moonlighting. Though, that would be on their own time, separate from resident responsibilities.
 
Residents are far less capable than fully trained and experienced CRNAs in my children's hospital. The same can't be said of the fellows though. The problem comes down to experience. Residents are only here for a few months and then the new batch of green residents arrive. We have CRNAs with decades of experience. The residents have more potential, but aren't here long enough to develop it.
I could do my own cases solo of course, and often do, but that's not the most economic option, or the best set up for my current practice.


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Il Destriero
 
oncology2020 said:
Really the value residents add is minimal? That's a bit ridiculous. In academic settings residents are doing most of the attendings work for them. We run the hospitals 24/7..I don't see many attendings cross covering nights. Some attendings even refuse to do bedside procedures like LPs, para's, line placements and instead dump it on the residents in the name of training and no many don't even bother to supervise. I have yet to see an attending do any bedside procedure.

If residents didn't add value you wouldn't see program leaders in many of the already saturated fields trying to add even more years of training or more residency spots despite already over training if it was hurting their bottom line (just look at the over training and the effects it has had at the detriment of the trainee in radiology, rad onc, pathology, anesthesiology, etc, many have to do further training just to keep a salary because the job market is so over saturated)..paying these residents and fellows a fraction of the cost of an attendings salary to run the hospital clearly benefits hospital administration which is why now midlevels are getting so much leeway because they too can do the work at the fraction of the cost of an MD attending. Trainees are clearly adding value for hospital administration in more ways than one..
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As L2D pointed out, many more hospitals don't have residents than do and they manage just fine. My residency (FM) was the only one in our hospital and it would have worked out just fine without us. The extra 5-8 admissions we did everyday wouldn't have slowed the hospitalists down, the 2-3 deliveries/day wouldn't have phased the OBs, and every July the peds service did OK without us since we didn't staff that service in July.
 
Giovanotto said:
So then by this logic, what to do we do next? Do we keep extending residencies (as the body of knowledge grows) and keep paying peanuts? I seriously can't follow this reasoning. I'm also pretty sure that after a few months (2-6?) of training a resident can carry out bread and butter procedures with minimal supervision. Isn't 90% of medicine repetitive anyways?

What I'm saying is that I can see why interns are paid peanuts (it' peanuts, lets not argue about this), since they are learning that particular hospital's emr and other nuances, but after that, I don't understand.
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Forgive me for being "that guy", but if your status is correct you haven't even started med school yet? And you're telling attendings how medicine and residency works?
 
Mad Jack said:
Residents are not doing the same job as midlevels, and are also being trained constantly, unlike midlevels. An NP doesn't require weekly didactics, on-call rooms, an entire academic department and infrastructure, etc. NPs only add resources while requiring nothing else in return. Residents decrease attending efficiency, increase hospital resource use, and generally require a lot of upkeep- they give but they take. It is, quite frankly, a stupid comparison.
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Are the midlevels in hospitals tend to be those with more years of experience? Or are we assuming that a fresh NP/PA grad adds more value to a hospital than a new resident. This probably sounds like a stupid question, but I'm just uneducated on the topic.
 
TaroBubbleTea said:
Are the midlevels in hospitals tend to be those with more years of experience? Or are we assuming that a fresh NP/PA grad adds more value to a hospital than a resident. This probably sounds like a stupid question, but I'm just uneducated on the topic.
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In an inpatient environment, places tend to only hire midlevels with experience or midlevels that trained at a given hospital so they knew what they were getting. Every place is different in regard to how they treat inexperienced midlevels, but where I worked they basically had a few months to learn the ropes and be fully functioning or they were canned. They also weren't paid very much to start- one of the NPs lamented that she made about the same as when she was a nurse, there was way less than a 10k difference in pay. As they got more experience, they could barely crack the 6 figure mark within half a decade or so, but there wasn't much room to go from there.
 
VA Hopeful Dr said:
Forgive me for being "that guy", but if your status is correct you haven't even started med school yet? And you're telling attendings how medicine and residency works?
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I'm probing/trying to understand or validate my assumptions. Logically, I struggle to see how a hospital employee can work for three-five years and still be a nuance not worthy of decent pay. I'm talking about working for 50-80hrs/week in a hospital, taking call, and not making what is minimum wage in some states (or what will be minimum wage). How many of those hours are spent learning/teaching? I'd wager that it's not even a tenth, or so I hear. In that case, I'd rather be payed more (or what I'm arguing is fair pay) and literally make it rain cash money on the attendings as they bless me with their knowledge.

Telling me its this way because its this way in other professions doesn't do anything to disprove my assumption. You can throw me those examples all day. Two wrongs don't make a right.
 
Giovanotto said:
I'm probing/trying to understand or validate my assumptions. Logically, I struggle to see how a hospital employee can work for three-five years and still be a nuance not worthy of decent pay. I'm talking about working for 50-80hrs/week in a hospital, taking call, and not making what is minimum wage in some states (or what will be minimum wage). How many of those hours are spent learning/teaching? I'd wager that it's not even a tenth, or so I hear. In that case, I'd rather be payed more (or what I'm arguing is fair pay) and literally make it rain cash money on the attendings as they bless me with their knowledge.

Telling me its this way because its this way in other professions doesn't do anything to disprove my assumption. You can throw me those examples all day. Two wrongs don't make a right.
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And you've got way more than two wrongs in your assumptions. You've got like, a pile of them. Interns are dangerous. Second year residents are often questionable. Third year residents are the ones that are finally reaching competency. I've heard many residents lament that even at the end of their training, they still didn't feel ready to practice safely- hell, even some surgical fellows felt that way. You neglect that training actually occurs, that an entire department infrastructure must exist to support your training and education, that attendings still do provide meaningful oversight, that you diminish the efficiency of attendings, that you cost hospitals extra money via excess testing, treatment inefficiency, and equipment use, etc etc. You're not a PA. You're not a NP. You're a resident who is receiving training tuition free while being paid. That's a pretty good deal. If they let the free market handle it, residents would be paying tuition in a lot of fields, much as they do in dentistry.

And your whining about minimum wage is pretty meh. We don't get paid hourly, we're professionals. I've known people in engineering, marketing, accounting, law, and finance that put in 80-100 hour weeks to make the same (or less) than we make early on in their careers so that they could speed their way up the ladder. And they weren't interns, they were fully paid professionals looking to become partners. Professionals aren't paid by the hour, minimum wage doesn't apply. And you're not putting in 80 hours a week every week in most fields, so stop doing your math based on that. A guy in anesthesia, for instance, is typically putting in 55-60 hours a week, putting their earnings at around $20/hr, hardly minimum wage. Psych you're looking at $23/hr at 50 hour weeks (and you can moonlight to make substantially more).

So chill out. You're not nearly as important, skilled, valuable, or necessary as you think you are. You'll realize that the further on you go in training. Hell, interns are typically so useless it's a miracle they get paid at all.
 
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Oh, and you could always try going to Europe, since that seems to be your thing- they've got lower pay than we do by a long shot, but lower hours as well. Our resident salaries make theirs pale in comparison.
 
mehc012 said:
Sorry, I meant more "thanks, reading those gave me an overview of one of the can of worms on here without having to actually open it, and will hopefully help me avoid inadvertently doing so in the future." But that's longer and doesn't sound half as good, so...
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Where is the fun in that?
 
Mad Jack said:
Oh, and you could always try going to Europe, since that seems to be your thing- they've got lower pay than we do by a long shot, but lower hours as well. Our resident salaries make theirs pale in comparison.
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And what do most physicians complain about? Time or money?
 
Why don't residents make as much as PAs? Low resident salaries are just another part of the sadistic hazing medical folk love so much. Anybody who tells you anything else is FOS. Some say its because medicare pays resident salaries, hospitals should supplement resident salaries for all the work residents do anyway. The whole " 1 attending can do the work of 5 residents" is bull crap, a lot of hospital systems would cave without all the low cost labor residents provide. Also for the guy who said " if residents were so valuable every crappy community hospital would try to open residency programs" if a lot of crappy community hospitals cold get accreditation for residency slots they would open residency programs. I honestly think all the crap you go through to become an attending-> college, med school, residency, all the unnecessary BS hoop jumping serves the purpose of making young attendings so bitter they demand ridiculous salaries, thus keeping the salaries high for all physicians.
 
psychMDhopefully said:
Some say its because medicare pays resident salaries, hospitals should supplement resident salaries for all the work residents do anyway.
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Who's going to foot the bill for the extra money then?

psychMDhopefully said:
if a lot of crappy community hospitals cold get accreditation for residency slots they would open residency programs.
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No, they wouldn't. My school relies solely on community hospitals for their residency programs. Over the past decade they've been trying to expand residency class size as well was open 4 new residency programs and 2 fellowship programs. The biggest opposition my school has faced in trying to expand and start these programs has been admin from these community hospitals. Their primary argument being that residents/fellows would eat up resources, attending productivity would drop, and overall to them it would be a net loss.
 
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psychMDhopefully said:
Why don't residents make as much as PAs? Low resident salaries are just another part of the sadistic hazing medical folk love so much. Anybody who tells you anything else is FOS. Some say its because medicare pays resident salaries, hospitals should supplement resident salaries for all the work residents do anyway. The whole " 1 attending can do the work of 5 residents" is bull crap, a lot of hospital systems would cave without all the low cost labor residents provide. Also for the guy who said " if residents were so valuable every crappy community hospital would try to open residency programs" if a lot of crappy community hospitals cold get accreditation for residency slots they would open residency programs. I honestly think all the crap you go through to become an attending-> college, med school, residency, all the unnecessary BS hoop jumping serves the purpose of making young attendings so bitter they demand ridiculous salaries, thus keeping the salaries high for all physicians.
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Once again you have no idea what you're talking about.
 
psychMDhopefully said:
if a lot of crappy community hospitals cold get accreditation for residency slots they would open residency programs.
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As someone with a firsthand view of community hospitals adapting to having residencies, this is the funniest thing I've read in a while. At best, they consider it a pain in the ass that they can tolerate for the sake of a reputation boost. At worst it's open warfare.
 
psychMDhopefully said:
Why don't residents make as much as PAs? Low resident salaries are just another part of the sadistic hazing medical folk love so much. Anybody who tells you anything else is FOS. Some say its because medicare pays resident salaries, hospitals should supplement resident salaries for all the work residents do anyway. The whole " 1 attending can do the work of 5 residents" is bull crap, a lot of hospital systems would cave without all the low cost labor residents provide. Also for the guy who said " if residents were so valuable every crappy community hospital would try to open residency programs" if a lot of crappy community hospitals cold get accreditation for residency slots they would open residency programs. I honestly think all the crap you go through to become an attending-> college, med school, residency, all the unnecessary BS hoop jumping serves the purpose of making young attendings so bitter they demand ridiculous salaries, thus keeping the salaries high for all physicians.
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I worked in a hospital for several years that had no trainees of any kind, and things worked just fine. Academic hospitals are set up to have trainees manage the services, etc. but they don't have to be. I think you overestimate the value of residents to the system and underestimate their cost.


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Il Destriero
 
psychMDhopefully said:
Why don't residents make as much as PAs? Low resident salaries are just another part of the sadistic hazing medical folk love so much. Anybody who tells you anything else is FOS. Some say its because medicare pays resident salaries, hospitals should supplement resident salaries for all the work residents do anyway. The whole " 1 attending can do the work of 5 residents" is bull crap, a lot of hospital systems would cave without all the low cost labor residents provide. Also for the guy who said " if residents were so valuable every crappy community hospital would try to open residency programs" if a lot of crappy community hospitals cold get accreditation for residency slots they would open residency programs. I honestly think all the crap you go through to become an attending-> college, med school, residency, all the unnecessary BS hoop jumping serves the purpose of making young attendings so bitter they demand ridiculous salaries, thus keeping the salaries high for all physicians.
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412f8aaff8469620292fd03a4eb22e64d95aa2fffb3f5e52aff5428c8fd56907.jpg

http://www.rand.org/content/dam/rand/pubs/research_reports/RR300/RR324/RAND_RR324.pdf

Depending on the size and efficiency of the department, extra residents can end up being a huge cost to a hospital. Larger residencies tend to do better on the income side of things than smaller ones, which often struggle to keep such small programs afloat. Community programs (which are, by and large, a HUGE number of programs) generally don't provide much for a hospital on the financial end that they couldn't get elsewhere for the same price (albeit with less turnover).
 
IlDestriero said:
I worked in a hospital for several years that had no trainees of any kind, and things worked just fine. Academic hospitals are set up to have trainees manage the services, etc. but they don't have to be. I think you overestimate the value of residents to the system and underestimate their cost.


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Il Destriero
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I don't remember the exact numbers, but once a hospital CEO told me that for IM, taking on a resident rather than a midlevel represented a loss for the hospital on the order of either tens or hundreds of thousands of dollars a year. In any case, it added up to enough to be significant to the hospital administrators.
 
Slack3r said:
Why we're wasting energy explaining the competency of residents to an MS0 is beyond me...
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I prefer to call him a MS -0.25, because something about being accepted but not yet starting medical school seems to actually put some people below the baseline of 0 knowledge-wise.
 
22031 Alum said:
I don't remember the exact numbers, but once a hospital CEO told me that for IM, taking on a resident rather than a midlevel represented a loss for the hospital on the order of either tens or hundreds of thousands of dollars a year. In any case, it added up to enough to be significant to the hospital administrators.
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Screen Shot 2016-05-10 at 4.26.07 PM.png

This provides a pretty rough picture of how much residents can have an impact on hospitals' bottom lines. Could cost six figures, could make six figures. It's highly dependent on the program, what their reimbursement situation is, and how many people a hospital actually needs to run the place efficiently. And this doesn't even take into account all of the infrastructure and educational resources required for a training program, which cost hundreds of thousands more to maintain per year.
 
To be fair, if a hospital can't manage to have their residents turn a profit for them that sounds like their problem. That doesn't preclude residents from getting fair wages. Hospitals can and should be setup to both train and take advantage of the inexpensive labor residents provide. Just because residents CAN negatively affect revenue at a hospital doesn't mean they always will, as the graph you've posted above demonstrates.
 
Mad Jack said:
I prefer to call him a MS -0.25, because something about being accepted but not yet starting medical school seems to actually put some people below the baseline of 0 knowledge-wise.
Click to expand...
I'm not gonna lie, I actually "lol"ed at this, and I'm pretty sure you just gave my girlfriend a nickname for me.
 
Mr. Hat said:
In summary:

Midlevels, including new ones, are competent practitioners after their 2 years of school, and make fistfuls of cash for the hospital by working 40 hours per week.

Physicians, after 4 years of school and even after a year or two of residency, are complete incompetent idiots who lose fistfuls of cash for the hospital by working 80 hours per week.

Why we continue to have medical schools in this country and don't just send everyone to PA or NP school is beyond me.

I think that sums the general thread up.
Click to expand...

I'm trying to comprehend how hospitals go net positive with a fresh new PA grad. It would make sense if they are with the hospital at least 1-2 years and they keep working there. I am surprise they generate revenue even sooner than that 1-2 year period.
 
Mr. Hat said:
In summary:

Midlevels, including new ones, are competent practitioners after their 2 years of school, and make fistfuls of cash for the hospital by working 40 hours per week.

Physicians, after 4 years of school and even after a year or two of residency, are complete incompetent idiots who lose fistfuls of cash for the hospital by working 80 hours per week.

Why we continue to have medical schools in this country and don't just send everyone to PA or NP school is beyond me.

I think that sums the general thread up.
Click to expand...
Midlevels and physicians are doing completely different things. A competent midlevel is competent at being a midlevel. A resident is not competent at being a physician. It's apples to oranges- one profession is a support profession, while the other is being trained to lead and coordinate. You don't need to be at a physician's level of competence to write discharge summaries, fill a chair in the unit while the surgeon is operating so the nurses have someone to write orders if something goes downhill, or to manage uncomplicated patients. As a resident, you are learning to manage the complicated patients, to be the guy that's operating, and to be the one that PA is calling when SHTF in the unit. You're not competent enough to be an attending, and that is why you are a trainee. PAs are competent enough to be a sidekick to the physician, but you're not learning to be a sidekick. You're learning to be a damn doctor, and that takes a lot of hard work, infrastructure, and investment of time and money on the part of hospitals and attending physicians (at least, if your residency program is any good it will).

It's like you're an apprentice electrician complaining that you're not making as much as the electrician's assistant (yes, those actually exist- the trades have almost identical hierarchies to the trade of medicine)- sure, you can do everything the assistant can do, but the electrician is putting time and effort into training you to do his job, not to just be a wire monkey that is only capable of following orders when things get complicated. Plus the guy you're apprenticing under wants to pay the assistant more to keep him around- you're there for the training, but he wants to retain his experienced (and efficient) assistant well into the future, something he won't be able to do if the guy down the street is paying more. But as an apprentice (or resident, in our case), there is no incentive to pay more for retention since you will one day be an independent professional that leaves upon the completion of your training.
 
IslandStyle808 said:
I'm trying to comprehend how hospitals go net positive with a fresh new PA grad. It would make sense if they are with the hospital at least 1-2 years and they keep working there. I am surprise they generate revenue even sooner than that 1-2 year period.
Click to expand...
I believe @Mad Jack addressed this earlier (too lazy to re-read the thread) - but basically if a mid level isn't functioning at the level they're expected to be within a month or two they're let go. That's at least how it was at 2 of my jobs prior to med school.
 
Mr. Hat said:
...
Physicians, after 4 years of school and even after a year or two of residency, are complete incompetent idiots who lose fistfuls of cash for the hospital by working 80 hours per week...
.
Click to expand...

What you are missing is that "medical school" isn't where you learn to be a doctor -- it's foundation. Residency is where your training BEGINS. In med school, you spend two years learning basic science, most of which you won't use for much day to day other than passing the steps. Then you spend a year where you really only spend 4-8 weeks in each specialty, to get a flavor but hardly learn to do much. It's just enough exposure to help you choose a specialty, but you aren't going to be of much subsequent value from that tiny stint. And then you take a few electives and interview in fourth year, match, and coast. So while you did 4 years of "medical school" you maybe spent a month in your future specialty. That's why it's such a steep learning curve in intern year, and why we are saying you aren't coming out of school as some valuable commodity. You are coming out with the foundation you need to get started.
 
IslandStyle808 said:
I'm trying to comprehend how hospitals go net positive with a fresh new PA grad. It would make sense if they are with the hospital at least 1-2 years and they keep working there. I am surprise they generate revenue even sooner than that 1-2 year period.
Click to expand...
Midlevels get to sink or swim. If you can't make it within 3-6 months, you're out on your ass. Not every midlevel is competent or capable, but they're easily replaced by the flood of new grads, particularly if you're working in a hospital, which seems to be the hot place that a lot of young new grads want to start out in. We also had kind of an unofficial ease-in transition program for nurses that had worked at the hospital and later become midlevels, because we knew that if they'd stuck with us this long, they'd probably keep sticking around, so they tended to get a bit of extra attention and support early on. But if you were an outsider? You've got a couple months to show us what you've got, and if you can't keep up, you can gtfo.
 
I real answer to this question is that simply hospitals don't have to pay residents as much as PAs. Residents (at least where i am) have no ability to negotiate their contracts. Economics 101: pay your workers as little as possible in order to retain them so that you can operate and profit. Residents are temporary workers and need that "trained" stamp. As an organization you would want to invest in your best long term prospects and I'm sure a midlevel provider that sticks around for 5+ years is worth more than a resident to a hospital system.

Although I certainly feel bitter a times about my salary/hours as an anesthesiology resident and dislike the fact that as an almost CA2 I feel I can do a significantly better job than a green CRNA and likely as good a job as an experienced CRNA with regards to delivering safe care, I'm sure I slow things down. I believe ACGME rules favor a 2:1 resident to attending ratio whereas attendings can supervise up to 4 CRNA rooms (depending on type of oversight, etc.). Furthermore, I often ask questions and try new things for my own edification that a CRNA may not do that can slow things down. This is simply the trade off. Soon enough the pressure will be on for peak efficiency to secure that attending salary
 
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