www.savethematch.org ...

[gasman2003]

orthoguy,

I take it from your postings that you honestly believe overworked residents never make mistakes as a direct result of sleep deprivation. What kind of fantasy world do you live in?

If you can tell me that you have never made a mistake as a result of sleep deprivation than I can confidently say you probably have never been through a residency program. If you don't have the guts to admit it yourself, then at least admit you have seen other residents make errors.

It is easy to see how a normally outstanding resident can make mistakes after being awake for 24 hours or more. Passing the blame to lack of attending supervision is not an adequate to argument to the issue at hand. We all know that it is common practice for admissions not to be seen until the next morning.

I don't understand why you are in denial...

---

Members don't see this ad.

 

[Mirror Form]

Originally posted by orthoguy
Hey medical student, did you ever hear the phrase it is better to keep your keep your mouth shut and let people think you are intelligent rather than opening your mouth and proving them wrong?

You have no idea how life works in a hospital if you do not believe that house staff make decisions without attending supervision. (perhaps you have only rotated through small private community hospitals) Spend a night in an ICU or perchance travel to a county ER at 3am or even walk into Columbia's medical floors after 6 pm and see what goes on.

Wow, it's pretty sad that you can't even figure out what a double negative means. I said that there's no medical resident who doesn't make decisions w/o direct attending supervision. That's another way of saying that every medical resident in the country makes decisions without direct attending input. Hence it's important for them not to be incredibly sleep deprived.

Sorry if that was too complex for you to understand, maybe you just need a little more sleep. And oh yeah, did I hear a personal insult in there? Uh oh, that must mean there's no substance to your argument

Originally posted by orthoguy
The report claimed that the "medically deficient care and treatment in this case" which included lack of supervision and overworked residents was "systemic" and posed a grave potential danger to patients.

Hmm, this indicates that the overworking of residents was a major part of the case. Didn't you say it was predominately about about direct attending supervision before? I guess that's just what you told yourself so as to corraborate with your preconceived views that orginate from your personal feelings instead of facts. Maybe you should try just keeping your mouth shut and letting us think you're an idiot, instead of continually opening it and removing all doubt.

 

[orthoguy]

Originally posted by Sledge2005
Wow, it's pretty sad that you can't even figure out what a double negative means. I said that there's no medical resident who doesn't make decisions w/o direct attending supervision. That's another way of saying that every medical resident in the country makes decisions without direct attending input. Hence it's important for them not to be incredibly sleep deprived.

LOL, yes I am sure this was your intention all along and that your misuse of the English langague was in fact a way to make a killer point.

Bravo!

 

[orthoguy]

And the problem, I must say with you AMSA junkies who cry "sleep-deprivation" are using anectdotal evidence to support your side and not scientific:

The Bell Commission: ethical implications for the training of physicians.

Holzman IR, Barnett SH.

Mount Sinai School of Medicine, Box 1508, One East 100th Street, New York, NY 10029, USA.

In 1989, the New York State Legislature enacted New York State Code 405 in response to the death of a patient in a New York City hospital. Code 405 was the culmination of a report (the Bell Commission Report) that implicated the training of residents as part of the problem leading to that tragic death. This paper explores the consequences of the regulatory changes in physician training. The sleep deprivation of house officers was considered a major issue requiring correction. There is little evidence to support the claim that sleep deprivation is a serious cause of medical misadventures. Nevertheless, the changes in house officers' working hours and responsibilities have profound implications. Changes in the time allotted to teaching, the ability to learn from patients admitted after a shift is over, and the increasing loss of continuity, all may have a negative impact on physician training. It is not clear that trainees are being realistically prepared for the actual practice of medicine - physicians often work extended hours. The most serious concern that has been raised is the loss of professionalism by physicians. Residents are now viewing themselves as hourly workers, and the State has intervened in an area of training formerly left to the profession to manage. We are now training doctors in New York State who will be comfortable working in an hourly wage setting, but not in the traditional practice of medicine as it has been in the United States during this century. We are concerned that this may sever the bond between doctor and patient - a bond that has been the bedrock of our conception of a physician.

PMID: 10747369 [PubMed - indexed for MEDLINE]

And if you want public reaction, go see this

http://www.newyorkmetro.com/nymetro/health/features/n_9426/index1.html

 

[Mirror Form]

Originally posted by orthoguy
LOL, yes I am sure this was your intention all along and that your misuse of the English langague was in fact a way to make a killer point.

This is hilarious, you've really taken your hypocrisy to a new level now if you're going to complain about people not using stellar grammar. Unless English isn't your first language you don't have any excuse for not being able to undertand sentences w/o perfect grammar. Although I guess that once again emphasizes the pointlessness trying to debate something with you.

 

[orthoguy]

Originally posted by Sledge2005
This is hilarious, you've really taken your hypocrisy to a new level now if you're going to complain about people not using stellar grammar. Unless English isn't your first language you don't have any excuse for not being able to undertand sentences w/o perfect grammar. Although I guess that once again emphasizes the pointlessness trying to debate something with you.

Ok, I have no concept of what you are talking about, you haven't answered any of the previous posts and I am lost as to what you think you are proving.

So I will await someone else who has something to say about what I had written before and ignore you as you are wasting my time.

 

[RedBlanket]

Originally posted by Sledge2005
This is hilarious, you've really taken your hypocrisy to a new level now if you're going to complain about people not using stellar grammar. Unless English isn't your first language you don't have any excuse for not being able to undertand sentences w/o perfect grammar. Although I guess that once again emphasizes the pointlessness trying to debate something with you.

Avoiding the landmine of this topic, I do want to say, Sledge2005 is absolutely in the wrong. The use of double negatives in written English is a fundamental error for a reason. Your sentence is logically difficult to process. For instance, when someone says "I ain't done nothing wrong", by your logic this means that they just admitted to doing something wrong. Clearly this is not the intention. Spanish for instance uses double negatives, but they do not "cancel" out as you seem to think.

In order to limit the amount of personal attacks on this thread I won't even comment on a "male"/"adult" user having a Garfield avatar.

 

[Mirror Form]

Originally posted by RedBlanket
Avoiding the landmine of this topic, I do want to say, Sledge2005 is absolutely in the wrong. The use of double negatives in written English is a fundamental error for a reason. Your sentence is logically difficult to process. For instance, when someone says "I ain't done nothing wrong", by your logic this means that they just admitted to doing something wrong. Clearly this is not the intention. Spanish for instance uses double negatives, but they do not "cancel" out as you seem to think.

Everyone is well aware that the use of double negatives is not good english. If I re-read all of my posts to make sure my grammar was flawless I would have changed it. That said, I really don't think the sentence was that difficult to comprehend and at the very least my point should have been obvious from the context. Your double negative example is horrendous b/c ain't ain't a word and furthermore that quote is almost more of a saying anyway.

Originally posted by RedBlanket
In order to limit the amount of personal attacks on this thread I won't even comment on a "male"/"adult" user having a Garfield avatar.

Ouch, that really hurt. You probably never read the garfield comics much, they were pretty good. I for one probably wouldn't have replied to a thread if I had nothing more to add then some grade school grammar lesson and a little jab about avatars. BTW, your simpsons avatar is so original.

 

[Mirror Form]

Originally posted by orthoguy
Ok, I have no concept of what you are talking about, you haven't answered any of the previous posts and I am lost as to what you think you are proving.

I just thought it was pretty funny how you have tons of posts with bad grammar, but then decided to bust on me for using one bad sentence, that's all. As to what I was proving, it's true that I never really took a stance on saving the match. I just wanted to point out that a lot of your arguments are contradictory and illogical. For example, you scoffed at the idea of getting your own account for SDN, but have been posting messages here very frequently for the past week . . . kind of strange.

 

[gasman2003]

If you can't even drive a car while sleepy, why should you be holding a scalpel (see below)?

Also, note that orthoguy never addressed my question about his personal experience and thoughts on medical errors and sleep deprivation.
FYI, I hate AMSA.... I am pro-patient safety though!

The road to danger: the comparative risks of driving while sleepy.

Powell NB, Schechtman KB, Riley RW, Li K, Troell R, Guilleminault C.

Stanford Sleep Disorders and Research Center, Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA. Laryngoscope 2001;111:887-893.


OBJECTIVES/HYPOTHESIS: A large sector of the population of the United States has sleep deprivation directly leading to excessive daytime sleepiness. The prevalence of excessive daytime sleepiness in this population ranges from 0.3% to 13.3%. The consequences of even 1 to 2 hours of sleep loss nightly may result in decrements in daytime functions resulting in human error, accidents, and catastrophic events. The magnitude of risks in the workplace or on the highways resulting from sleepiness is not fully understood or appreciated by the general population. Hence, to more clearly emphasize the magnitude of these risks, we question whether mild sleep deprivation may have the same effect as alcohol on reaction times and driving performance. STUDY DESIGN: Nonrandomized prospective cohort investigation. METHODS: Sixteen healthy matched adult subjects (50% women) were stratified into two groups, sleep deprived and alcohol challenged. The sleep-deprived group was further subdivided into acute (one night without sleep) and chronic (2 h less sleep nightly for 7 d) sleep deprivation. Each group underwent baseline reaction time testing and then drove on a closed course set up to test performance. Seven days later, the group repeated this sequence after either sleep deprivation or alcohol intake. RESULTS: There were no significant between-group differences (sleep deprivation or alcohol challenged) in the changes before and after intervention for all 11 reaction time test metrics. Moreover, with few exceptions, the magnitude of change was nearly identical in the two groups, despite a mean blood alcohol concentration of 0.089 g/dL in the alcohol-challenged group. On-track driving performances were similar (P =.724) when change scores (hits and errors) between groups were compared (baseline minus final driving trial). CONCLUSION: This comparative model suggests that the potential risks of driving while sleepy are at least as dangerous as the risks of driving illegally under the influence of alcohol.

I am not going to list the numerous other studies I found to support this because everyone here (except orthoguy) understands that lack of sleep relates to poor cognition and coordination. This study was simply easy to find on-line.

I wish we all had the superhuman abilities (both in written language and in the sleep deprived practice of medicine) possessed by orthoguy.

 

[drusso]

Orthoguy,

Read the book "Good to Great" by Jim Collins about how to reform organizations and make "good" organizations truly great. As long as we passively accept the current system there can be no meaningful change. "Good" is the enemy of "Great."

You and others who support "business as usual" only complain about all the possible things that can go wrong if we change the system, but have yet to offer one COMPELLING argument about why the current system is good. You don't want to change, but you don't explain why you think what we have is working.

You can start by answering just one simple question, "What are you gaining from the way things are currently structured that would be negatively impacted if change were undertaken?"

 

[Seaglass]

You can start by answering just one simple question, "What are you gaining from the way things are currently structured that would be negatively impacted if change were undertaken?"

Currently I have the luxury of:
1) a low stress applying environment with a guaranteed base level of pay regardless of training location with some base level of benefits

2) the advantage of not having to make a decision until February of my senior year and

3) the knowledge that I will be given a position at the best possible institution compatible with my match list

If the match is abolished:
1) I am guaranteed nothing. I am pretty competitive so I guess I would still do alright, but someof my classmates would probably be looking at lower salaries or, as some other posters have mentioned, even a pay-to-work position in competitive specialties like Ortho or Derm.

2) I will likely have to make a decision much earlier in the year,possibly before having interviewed at all the institutions I am interested in, this could lead to

3) matching at a suboptimal institution since I will likely have to decide earlier or take a position based on higher pay rates

Personally, I think that the things we want (higher pay, better benefits, better work environment) would be better achieved by unionizing than by abolishing the match. The match works great for what it is, these other problems aren't necessarily related to the match.

Casey

 

[drusso]

Originally posted by cg1155
Currently I have the luxury of:
1) a low stress applying environment with a guaranteed base level of pay regardless of training location with some base level of benefits

2) the advantage of not having to make a decision until February of my senior year and

3) the knowledge that I will be given a position at the best possible institution compatible with my match list

If the match is abolished:
1) I am guaranteed nothing. I am pretty competitive so I guess I would still do alright, but someof my classmates would probably be looking at lower salaries or, as some other posters have mentioned, even a pay-to-work position in competitive specialties like Ortho or Derm.

2) I will likely have to make a decision much earlier in the year,possibly before having interviewed at all the institutions I am interested in, this could lead to

3) matching at a suboptimal institution since I will likely have to decide earlier or take a position based on higher pay rates

Personally, I think that the things we want (higher pay, better benefits, better work environment) would be better achieved by unionizing than by abolishing the match. The match works great for what it is, these other problems aren't necessarily related to the match.

Casey

#1: Why do you think this would change. Trust the market. No one is going to work for free, nor can afford to work for free, regardless of how prestigious a program is. Prestigious places will want to attract elite people. Elite people know what they're worth.

#2: The "new" match could be structured so that there was an "offer day." On this day, everyone would find out which programs were offering them spots. They could then negotiate with different program based on geography, cost of living, etc. A new match that incorporates these features is workable.

#3: You would work an institution that offered you a spot. You would be able to have competing institutions refine their offers based upon how good of a candidate they thought you were and how badly you wanted to work for them.

This is how other young professionals run their lives. You *CAN* and *SHOULD* compete just like they do by weighing competing offers and negotiating salaries. Residency is not a continuation of medical school where the medical school takes care of you and watches out for you. It's "big boy" and "big girl" school.

 

[Andrew_Doan]

Originally posted by drusso
#1: Why do you think this would change. Trust the market. No one is going to work for free, nor can afford to work for free, regardless of how prestigious a program is. Prestigious places will want to attract elite people. Elite people know what they're worth.

Actually, I'm sure there will be plenty of people who will work for free/low pay. It's a big deal to walk away from residency being Harvard trained. The bottom line is that physicians can't do anything without residency.

In my field, military physicians seeking ophthalmology fellowships are highly competitive at the top programs: Harvard, Hopkins, Wills, etc... Why is this? Because the military pays their salaries and programs don't have to pay the fellow.

I think we need to be careful with this issue because our predecessors struggled when there was no matching program. The matching program made things fair. One last point, our salaries are supported by Medicare, and I don't see how hospitals can really raise our benefits and salaries. If Medicare crashes, then I've even heard arguements from clinical professors that residents should instead pay tuition.

We should all keep in mind that being trained as residents is truly a privilege.

 

[Seaglass]

#1: Why do you think this would change. Trust the market. No one is going to work for free, nor can afford to work for free, regardless of how prestigious a program is. Prestigious places will want to attract elite people. Elite people know what they're worth.

#2: The "new" match could be structured so that there was an "offer day." On this day, everyone would find out which programs were offering them spots. They could then negotiate with different program based on geography, cost of living, etc. A new match that incorporates these features is workable.

#3: You would work an institution that offered you a spot. You would be able to have competing institutions refine their offers based upon how good of a candidate they thought you were and how badly you wanted to work for them.

This is how other young professionals run their lives. You *CAN* and *SHOULD* compete just like they do by weighing competing offers and negotiating salaries. Residency is not a continuation of medical school where the medical school takes care of you and watches out for you. It's "big boy" and "big girl" school.

#1) All over America people are working for low pay. It is customary to work for less than you're worth in competitive fields or to gain a competitive position. I refer you back to the law student thread. Plenty of graduating lawyers who weren't #1 in their class end up working starting positions for less than their worth. And, we have little bargaining power because, as the previous poster stated, we can't do anything without going to a residency. Add on to that the fact that there are hundreds of IMG's looking to get into the limited number of residency slots here and it is IMPOSSIBLE to make any predicitions about the benefits of a free market system.

#2) Your solution doesn't really change anything. The fact is there are generally a limited number of spots for a large number of applicants. On offer day I could have Harvard saying "Well, we'll pay you 30k and we really want you but we only have 2 spots left so hurry up and decide." How is that better for me?

#3) I refer back to my response for #2

As to your closing argument, aside from being condescending, I take exception to these points. How we work is NOTHING like how other young professionals live their lives. We do not have the leverage they do. We do not generally have the financial reserves to use as bargaining power. We do not have the ability to earn an income independantly of a residency program. We cannot easily translate our job skills into fields with comparable compensation and most of us don't want to. Some others have proposed that we are just labor for the hospital. Well, in a free market the work goes towards the lowest bidder and there are plenty of FMG's out there willing to be the lowest bidder. Not every program has a reputation to maintain that justifies paying big bucks to residents. I still believe that unionization is the best road to improving these aspects of residency training.

Now in the last paragraph here you say that we should compete for spots. Now a competition involves winners and losers. So how is this good for everyone--someone has to be the loser.

The way I see it those who want to do away with the match have a sort of "me first" mentailty: "I'm great, I aced the boards, now pay me a lot of money. I don't care if my classmates get screwed in the process." Well, I'm more interested in a fair system, which is what the match currently is.

Casey

 

[Whisker Barrel Cortex]

As an example of people working for no pay, the Musculoskeletal radiology fellowship at University of California, San Diego offers no pay. The reason is that you work with the biggest name in MSK radiology Dr. Resnick and you get to live in San Diego, both of which make this a great job.

 

[drusso]

The problem I see with what detractors are arguing is that they are only looking at one curve--the supply curve. There is another curve--the demand curve (which as a component of it takes into consideration the applicant quality). It seems that detractors really don't think that USMG's are "in demand" by hospitals. I think that they underestimate the value of USMG's in today's healthcare system. Where those curves intersect--the equilibrium--is the "fair market price" for the work that residents do. Residency programs are training programs, yes, but they also depend upon residents for service obligations.

The vast majority of people will not work for free. It's just not financially tenable. If people knew applying to medical school that upon graduation they could expect 3-7 years of employment with no pay, medical school admissions would plummet. Residents have to earn some money for what they do (in fact the ACGME mandates paying residents a part of the accreditation process so that programs like Harvard or Hopkins that will only try to attract candidates based on brand-name recognition alone would risk losing their programs).

The match promotes a kind of Orwellian "fairness" by in fact promoting anticompetition. Thus, in all subsequent posts we should instead refer to "the match" as "the ultimatum" because that is what it really is. By simply registering for the ultimatum you agree to accept its outcome. While it is possible to break ultimatum contracts, this is technically punishable by law. Stakeholders of the ultimatum (residency programs, hospitals, and the ACGME) can sue you although this action is rarely if ever taken.

The argument that without a residency ultimatum things will reverse to chaos as they did in the pre-ultimatum days is nonsense because the dynamics of house staff employment are completely different today compared to back then. Back in the bad old days, medical school graduates applied to training hospitals in their local areas. With no internet, no fax machines, and barely reliable long-distance telecommunications (unless you count the telegraph), weighing and comparing competing offers was difficult. Hospitals and programs could make ridiculous offers (exploding offers, etc) and candidates just didn't know any better. Today, however, knowledge is power. Applicants have databases and reams of information about programs at their disposal.

I have not *EVER* argued to completely do away with the ultimatum. Certain features of the ultimatum actually promote efficiency--for example a centralized application process. Other efficient aspects of the ultimatum could be retained and rules about "exploding offers, etc" could be enforced by accreditation loss. What is anticompetitive is the inablility to know which programs want you, how badly, and what they are willing to do to accomodate your arrival. In my own ultimatum experience, one very prestigious, east coast, ivy-league institution contacted me regarding residency employment information and a contract for employment prior to ultimatum day. I promptly reported them to the NRMP (a.k.a. the NRUP) because this behavior is supposed to be strictly forbidden under the rules of the ultimatum.

All in all, the ultimatum worked out fine for me (I got my first "choice"---making the entire ultimatum experience for me more of a Don Carleonesque "offer I couldn't refuse" experience) because I was a very competitive prospective employee. For me, the institution's preferences and my own were clearly congruent. Nevertheless, I regret not having the knowledge that the institution wanted me and the luxury of sitting down across a desk from someone and saying, "alright let's make this a win-win situation."

At bottom: I am philosophically opposed to the underlying principles of the ultimatum. There is no other circumstance in life where one must accept this kind of arrangement: Marriage? College? Medical School Admissions? Let the prospective employees and employers sit down and negotiate their contracts just like millions of people do in the real world every day. Patients will not go to hospitals that employee "slave labor" FMGs. The ACGME will not accredit residencies that promote "labor camp" conditions. Training programs that can't offer competitive wages, working conditions, and a quality education will have to shut down. And, on top of all of this, resident physicians can still unionize!

 

[orthoguy]

Originally posted by drusso
The problem I see with what detractors are arguing is that they are only looking at one curve--the supply curve. There is another curve--the demand curve (which as a component of it takes into consideration the applicant quality). It seems that detractors really don't think that USMG's are "in demand" by hospitals. I think that they underestimate the value of USMG's in today's healthcare system. Where those curves intersect--the equilibrium--is the "fair market price" for the work that residents do. Residency programs are training programs, yes, but they also depend upon residents for service obligations.

You still just do not understand where our salaries come from, do you.

 

[drusso]

Originally posted by orthoguy
You still just do not understand where our salaries come from, do you.

I know exactly where it comes from--Medicare. Hospitals are paid 80K-100K per resident. About 60% of that gets siphoned off into "indirect costs" of resident education and "subsidizing indigent care." Does social justice to *YOU* equal subsidizing indigent care on the backs of resident physicians? I see where it's a win-win for the government, the hospital and the indigent, but how does the resident win?

And, don't tell me they win with the opportunity to care for the indigent. That's the wrong answer. If the government wants to subsidize indigent care let them do it directly and not off the fat of inflated "training costs" paid to hospitals. Why do you think the number of residency slots were expanding up until about 7 years ago? Because hospitals make money on training residents both in actual direct RVU's (they bill for us!) and in indirect cost shifting (attendings stay at home and residents work nights!).

 

[orthoguy]

Originally posted by flindophile
I don't see how medicine is different from any other profession. In most of the world, an employee's value increases as they gain knowledge and experience. I would think that the skill set of residents is at least equivalent to that of NPs, PAs, and nurses. The market has set a value on this skill set that is higher than that paid to residents. Why is this so?

One of the problems newly minted MD students face is a lack of alternatives. I have often wondered what would happen if MD graduates were automatically qualified to work as PAs. This would give MDs an option earning a reasonable salary while they consider offers from resident programs. Also, if resident programs did not all begin at the same time, you could take your time in looking (like in any other job). I think this might do a lot to change the dynamics of the resident job market and make it less of a buyers market.

This individual also seems to not understand that residency is a necessary transition from being a medical student to being a physician. We are not PA's.

Further, I love these individuals who compare residency to any other profession, there is no analogy. 1) Residency is necessary training 2) We work at hospitals that care for patients and most of these are operating in the red. Our salaries are paid for by Medicare. In order to increase our salaries you need to either increase Medicare subsidies (this will come either as a tax increase or a cut in Medicare benefits) or by a cut in patient services provided by the hospital. There is no way to raise our salaries without it being the expense of the public in one way or another.

The individuals who believe there is this untapped resource of increased wages are being very naive and sophomoric.

 

[Entei]

Originally posted by drusso
At bottom: I am philosophically opposed to the underlying principles of the ultimatum. There is no other circumstance in life where one must accept this kind of arrangement: Marriage? College? Medical School Admissions?

I quoted this little piece of drusso's post because it reminds me of the debates that ran rampant on pre-allo a few short months ago when lots of pre-meds were actually wishing that there WAS a "med school match." I guess you just can't please everyone.

Regardless of orthoguy's other posts, I think he's making important points about the Match. Maybe this is just a result of my naive misunderstanding of how the Match works, but I don't see how it's a tricky ultimatum. An applicant only ranks programs that he or she would want to work at, right? So how is that applicant forced to go somewhere he or she doesn't want to go? And how is it hard to figure out how much a program is interested in you? Don't you just match at the one that likes you the best anyway?

I don't understand how we could possibly expect salaries at the "hot shot" programs NOT to go down if we did away with the Match. So the programs still have to pay you. So what? They could pay you in Monopoly money, and people would still want to train there. A similar thing happens at the med school level. There are plenty of applicants who turn down either scholarships or the lower cost of their state med school to train at a more prestigious private school. They're willing to pay extra for the name and the "wow" factor. You mean to tell me that this mindset won't persist during residency? What changes?

Sure, it would be great to "have our cake and eat it too," but until someone figures out a concrete way to DEFINITELY make it work, I don't see why we should do away with the present system that, by your own admission, works ok. I'm not comfortable with such a drastic action as doing away with the Match based on a few "maybes" and "what if" speculations about free market dynamics. Isn't everyone looking to cut costs nowadays? Where exactly WOULD this extra money come from, and why would they throw it at residents who are more than willing to make certain trade-offs for salary anyway?

Of course, I'm just an MS1, and if there's one thing I understand, it's that I don't understand anything. Maybe I just don't "get" this either.

 

[orthoguy]

Originally posted by drusso
Because hospitals make money on training residents both in actual direct RVU's (they bill for us!) and in indirect cost shifting (attendings stay at home and residents work nights!).

I am sure your angst must come from many a back-breaking PM&R night call.

 

[Seaglass]

The crux of Dr. Russo's argument seems to be that a free market for resident physician labor would increase wages for residents, specifically highly competitive residents. With this I would agree, a highly competitive resident would be more likely to be able to negotiate for higher wages. But he seems to extend this reasoning to hold for all residents. History shows that this is not the case. I bet that no one can name even one labor market where a non-organized bulk labor force has seen wages increase over time beyond inflation. And you can't count Fortune 500 CEO's as a catagory!

Residency is not like other jobs. Not because it's "medicine," like orthoguy seems to think, but because there are hundreds of people applying for basically the same job at the same time every year. A free market approach simply does not benefit everyone in this situation. If you don't like the match, you always have the option of not participating. (LOL)

Dr. Russo, I think it would be nice if you would simply admit that your idea would not benefit everyone, and that some may even have it worse off than they do now. If you can't honestly admit that then I wonder just what you are basing your arguments on.

Casey

 

[edmadison]

Originally posted by gasman2003
This is where the courts will intervene to protect our rights to due process.

I don't know exactly what the changes will be. Perhaps the Match will be found constitutional, but the compensation issues won't, or vice versa.

The lawsuit has nothing to do with the constitution or the right to due process. It is a question of whether the match violates one of several antitrust statutes enacted by congress over the past 100 years. There is little doubt in my mind that it does and I find it unlikely that a court would find otherwise. In any event if some court did find that the match was a monopoly, you will be able to use an eggtimer to measure the time it will take congress to amend the statute. Who do you think has more clout with congress? Medical students or health care corporations?

On another note, the lack of a match would be chaos. How would a program be able to simultaneously negotiate with 50, 100 or even 300 or more applicants -- it simply impossible. 15,000+ applicants applying for all those slots. There will have to be some organization to the process.

Ed

 

[huktonfonix]

The match does have its good points and bad points as stated ad nauseum in this thread. The bottom line is however, that residents are extremely underpaid for the amount of work they do. It is also disturbing to hear residents in some areas saying that they have to worry about paying their phone bills and having their service cut off in addition to having a 150K + debt. Should our future physicians have to live in relative poverty during their training and early practice? It would be interesting to know how much hospitals do indeed profit off resident labor and if any of that could be used to raise resident salary. It would never happen, but something to think about.

 

[1996]

Originally posted by drusso
The problem I see with what detractors are arguing is that they are only looking at one curve--the supply curve. There is another curve--the demand curve (which as a component of it takes into consideration the applicant quality). It seems that detractors really don't think that USMG's are "in demand" by hospitals. I think that they underestimate the value of USMG's in today's healthcare system. Where those curves intersect--the equilibrium--is the "fair market price" for the work that residents do. Residency programs are training programs, yes, but they also depend upon residents for service obligations.

Let's say you apply this supply-demand model to the residency application process. If you look at the number of applicants to the more competitive residencies like derm, rads, plastics, ortho, ophthal, ENT, etc. and the number of positions available in each, what do you think will have happen to the resident's salary in these specialties? Now let's look at the less competitive family medicine, IM, or peds, what would happen to the primary care fields? You will probably end up with derm and rads spots paying 10K per year and IM or peds spots paying 50K per year. How would that make it more fair for all med school grads?

Given that there are more applicants in these competitive fields than there are spots available, the resident salary for these specialties will be driven extremely low. What would probably happen then? Someone with rich parents who paid for their med school and continue to pay for their living will stick it out with these competitive specialties despite the low salary, while another, equally or more qualified, applicant from more disadvantaged backgrounds with >150K debt will be forced to switch to another specialty with higher pays during residency just to make ends meet. You think that would be a better system for all?

 

[Apollyon]

Originally posted by edmadison
On another note, the lack of a match would be chaos. How would a program be able to simultaneously negotiate with 50, 100 or even 300 or more applicants -- it simply impossible. 15,000+ applicants applying for all those slots. There will have to be some organization to the process.

I WAS going to say, "Major League Baseball", in that the network of scouts goes out all over and picks and chooses who they want (and, as such, would be a parallel), but then I remembered MLB has an antitrust exception. That is a story in itself.

 

[rirriri]

Originally posted by Apollyon
I WAS going to say, "Major League Baseball", in that the network of scouts goes out all over and picks and chooses who they want (and, as such, would be a parallel), but then I remembered MLB has an antitrust exception. That is a story in itself.

LOL. i can't imagine PDs coming over to my apartment to recruit me! HAHA. I would serve them Coffee and Candy and let them shuffle through my record collection. Even offer them a Cigar.

maybe you are on to something with this MLB comparison. In essence, Residency is equivelant to the "Minor Leagues" and serves as the same type of training farm system.

Bottom line, this lawsuit is going nowhere...the Match will remain. We have it MUCH MUCH easier than previous generations, who had to apply via snail mail seperately to EVERY program they were interested in. We just click the buttons and pay for it and have it easy. NRMP does all the dirty work for us....if the match didn't exist, we would probably spend about a month sitting on the telephone asking "can i have a job?" and "don't you want me....baby?"

This lawsuit is made for whiners who love to complain about any system in effect. I hate systems, but if it works, then it works.

KILL THE GOVERNMENT (it doesn't work)

cheers

 

[gasman2003]

Assuming that Congress is going to bail out the results of the lawsuit is presumtious at best.

If the courts find the current system in violation of anti-trust laws (which it will), Congress is not going to amend the laws to allow illegal activity.

The end result could very well be an unchanged Match system with the presence of resident unions. Who knows.

Many posters (such as orthoguy) seem to favor the status quo out of fear of change. If we went back to the system before the match existed he would probably be making the same argument. The sky is falling the sky is falling type statements. Yet the match was created and the world didn't end.

Now there are people who are making a strong argument that the Match system needs to be changed so that residents aren't forced to live in meager conditions, and people like orthoguy can't fathom a viable solution. He falls back on arguments such as there is no money for increased salaries, etc.

Every hospital has more nurses than physicians, the average salary for an RN in the US is $45-52,000. Their pay has increased 9.2% in the past year. If RNs can get raises of this nature, and they outnumber us, surely there are funds available for us to have pay increases as well. Administrative costs (i.e. insurance company executive, CEOs, etc.) soak up a considerable portion of healthcare revenue, so we know there are extra dollars out there. Plus, hospitals are reimbursed more than the cost of each resident per year. We make on average $35,000/year and I believe the hospitals get $80,000+ for each of us/year. I don't know how people can live with such negative and incorrect thought processes such as to assume that organized medical education would collapse if we all get raises in proportion to the rest of hospital employees.

 

[1996]

Originally posted by gasman2003
Assuming that Congress is going to bail out the results of the lawsuit is presumtious at best.

If the courts find the current system in violation of anti-trust laws (which it will), Congress is not going to amend the laws to allow illegal activity.

The end result could very well be an unchanged Match system with the presence of resident unions. Who knows.

Many posters (such as orthoguy) seem to favor the status quo out of fear of change. If we went back to the system before the match existed he would probably be making the same argument. The sky is falling the sky is falling type statements. Yet the match was created and the world didn't end.

Now there are people who are making a strong argument that the Match system needs to be changed so that residents aren't forced to live in meager conditions, and people like orthoguy can't fathom a viable solution. He falls back on arguments such as there is no money for increased salaries, etc.

Every hospital has more nurses than physicians, the average salary for an RN in the US is $45-52,000. Their pay has increased 9.2% in the past year. If RNs can get raises of this nature, and they outnumber us, surely there are funds available for us to have pay increases as well. Administrative costs (i.e. insurance company executive, CEOs, etc.) soak up a considerable portion of healthcare revenue, so we know there are extra dollars out there. Plus, hospitals are reimbursed more than the cost of each resident per year. We make on average $35,000/year and I believe the hospitals get $80,000+ for each of us/year. I don't know how people can live with such negative and incorrect thought processes such as to assume that organized medical education would collapse if we all get raises in proportion to the rest of hospital employees.

I think many of us who are opposed to changing the current format of the match believe so not because we fear changes. I am opposed to it because no one can convince me that there is a better way to do it then the current match system. None of the suggestions made by posters in favor of the lawsuit (e.g. drusso, gasman2003, etc.) convinced me that they would be better, more efficient, and more fair than the current system. I am all for changes if it is for the better, but why change something if it actually makes the situation worse?

 

[trauma_junky]

Originally posted by GeddyLee
Hey Trauma_junky,

good luck on getting into medical school

Maybe you can explain where my reasoning fails? Otherwise, go back to beating off over which med school you'll be accepted to, and stop posting on the "General Residency Issues" forum like the know-it-all prick that you are.

You are so far removed from this whole issue, the only thing you can contribute are things that you heard from someone else...

Hey Kenny G, I smell a bed pan that needs changing! The reasoning is plan and simple as it has been in NY for the past 19 years!

 

[gasman2003]

I am not pretending to have all the answers to this issue, nor do I have the expertise to suggest a flawless alternative system, but what I do know is that the situation will be changed.

Try to keep an open-mind, perhaps think of solutions or options, so that when the time for change comes we can perhaps all contribute something towards it.

To simply insist that the current situation is the only way to accomplish things is a mistake. There has to be a better way to organize and execute this process so that we can have more flexibility and better compensation.

And why do I keep focusing on the compensation? Well, first I do not have parents who pay my bills so my salary has to stretch (like thousands of other residents). We work large amounts of hours (often times the equivalent of 2 full-time jobs) while we watch our student loan debts double in size.

Second, the compensation aspect of the lawsuit is where the Match is in the most jeopardy. The non-negotiable nature of our salaries is what may be the downfall of the Match. Requiring us to be "employees" (i.e. paying taxes, etc.) and telling us we are "students" so they can price-fix our salaries is not going to pass the legal challenge.

As physicians we have a high value in this society. The medical education system cannot go on forever working us 80+ hours/week, and deciding what salaries they are going to pay us while they do so. It is time for the pendulum of control to start swinging back in favor of students/residents.

 

[Mirror Form]

Originally posted by 1996
You will probably end up with derm and rads spots paying 10K per year and IM or peds spots paying 50K per year. How would that make it more fair for all med school grads?

Since the most competetive residencies (eg derm and rads) also make much more money after getting licensed then the non-competetive ones (eg. IM or peds), it actually does seems much more fair for all medical grads!

I'll admit I haven't yet gone through the match and don't fully understand the details of it. But could someone please explain to me why if highly competetive derm programs wanted to pay lower salaries, how are they prevented from doing so by the match? Why don't hopkins derm residents currently make only 17K per year? They'd definitely still fill their spots with decent candidates. If these programs were truly dedicated to cutting resident salaries further, why aren't the more competetive ones paying less right now? Does the match in someway regulate salaries????

 

[orthoguy]

God this grows tiresome.....

NOTE TO ALL: Stop arguing with gasman/drusso and the pre-med Garfield guy. They do not exist in the real world and still think that they have devised a clever way to get us all more money by suing the match. No matter how logically you argue with them, they will not budge. Every one has made reasonable and well thought out arguments FOR the match, why it works, and how it should be kept in place. To this they have responded with the *****ic "well you are afraid of change" or with a sob story about how their parents didn't fund their education (as if so many of us have gotten a free ride on our parents), or how we can simply increase Medicare subsidies/cut ancillary services/or decrease patient activities in a hospital to make us more dough. They will further dazzle you with their Marxian rhetoric about how hospitals make profits on the backs of the "working class" err, resident class or how there are residents who live in <weep> poverty and cannot <sob> afford to pay their bills when they only make 47k/year. (Maybe they should have looked into loan forbearance).

The point here is no matter how realistic we argue, they simply come back with something ignorant, uninformed, and uneducated. They have not thought this through, they do not care what will happen to other less qualified applicants or explain where the extra money will come from, they only see how it will and can benefit them.

So I say let this thread die. It is useless to argue with individuals who refuse to allow a modicum of reason into their viewpoints, so why waste our time?

 

[drvlad2004]

It is obvious that orthoguy is a bigot and thinks everybody sees things his way. I am skeptical about people, like him, when it comes to showing prejudice. Who knows what other forms of prejudice that he may have. I also find it funny, whenever someone responds to his argument, he immediately feels personally attacked as if it is a panic disorder. It is a mockery to medicine that we have people like orthoguy in this profession; that is if he really is a medical student or whatever he has been pretending to be (obviously he is not the real orthoguy). I can't even take this guy seriously when he has steal another person's SDN identity.

 

[Mirror Form]

Originally posted by orthoguy
God this grows tiresome.....

NOTE TO ALL: Stop arguing with gasman/drusso and the pre-med Garfield guy. They do not exist in the real world and still think that they have devised a clever way to get us all more money by suing the match. No matter how logically you argue with them, they will not budge. Every one has made reasonable and well thought out arguments FOR the match, why it works, and how it should be kept in place. To this they have responded with the *****ic "well you are afraid of change" or with a sob story about how their parents didn't fund their education (as if so many of us have gotten a free ride on our parents), or how we can simply increase Medicare subsidies/cut ancillary services/or decrease patient activities in a hospital to make us more dough. They will further dazzle you with their Marxian rhetoric about how hospitals make profits on the backs of the "working class" err, resident class or how there are residents who live in <weep> poverty and cannot <sob> afford to pay their bills when they only make 47k/year. (Maybe they should have looked into loan forbearance).

The point here is no matter how realistic we argue, they simply come back with something ignorant, uninformed, and uneducated. They have not thought this through, they do not care what will happen to other less qualified applicants or explain where the extra money will come from, they only see how it will and can benefit them.

So I say let this thread die. It is useless to argue with individuals who refuse to allow a modicum of reason into their viewpoints, so why waste our time?

Well, another typical orthoguy post. Normally posts this *****onic don't really deserve replies. However, I feel the need to point out that it's a big mistake to ridicule that doctors and groups (eg amsa) who're trying to improve things. Most doctors seemed very happy to sit around complaining (but doing nothing) as health care fell into the hands of HMO's and basically went to $hit over the past decade. It literally makes me sick every week in the hospital when another dx suddenly stops being covered. Before this lawsuit on the match, med grads weren't even allowed to see their contract before they matched and were required to sign!

As far as the match goes, I applied to many medical schools w/o a match system and it really wasn't that big of a deal. Until someone gives a better reason for why salaries would decrease w/o the match, I don't see what the point of it is.

 

[orthoguy]

Originally posted by drvlad2004
It is obvious that orthoguy is a bigot and thinks everybody sees things his way. I am skeptical about people, like him, when it comes to showing prejudice. Who knows what other forms of prejudice that he may have. I also find it funny, whenever someone responds to his argument, he immediately feels personally attacked as if it is a panic disorder. It is a mockery to medicine that we have people like orthoguy in this profession; that is if he really is a medical student or whatever he has been pretending to be (obviously he is not the real orthoguy). I can't even take this guy seriously when he has steal another person's SDN identity.

Perhaps you should read ALL of my posts on this forum where I have argued my viewpoint logically and see the last post for what it is, my throwing my hands up in the air and stating that "no matter what I do certain individuals argue the same moot points regardless".

Post Script: I LOVE when people think they are able to analyze me based upon a message board. Am I that threatening to you?

 

[gasman2003]

Isn't this a breath of fresh air?
Orthoguy thinking he is the one who is in touch with reality... Maybe if it was 1950. This from the guy who still can't figure out how to get his own username.
I am no longer responding to orthoguy's posts. Why should I since he is always right?
Request to moderator: Please rename the forums to www.studentdoctororthoguy.net...

 

[1996]

Originally posted by gasman2003

Second, the compensation aspect of the lawsuit is where the Match is in the most jeopardy. The non-negotiable nature of our salaries is what may be the downfall of the Match. Requiring us to be "employees" (i.e. paying taxes, etc.) and telling us we are "students" so they can price-fix our salaries is not going to pass the legal challenge.

As physicians we have a high value in this society. The medical education system cannot go on forever working us 80+ hours/week, and deciding what salaries they are going to pay us while they do so. It is time for the pendulum of control to start swinging back in favor of students/residents.

I don't think that the non-negotiable nature of our salaries is necessary the fault of the match. Remember that we are given the info about how much each program pays before we rank our programs. There is still competition among programs in terms of salary (salary among programs can range from 33K to 42K for an intern). If an individual thinks that salary is the most important criteria for him/her, he/she can submit a rank list done completely according to the individual program's salary and benefits. We still have the choosing power in our own hands.

If you are talking about why residents are underpaid overall in terms of salary, the main reason I see is that we don't have a union sort of organization to collective-bargain for us. I don't see how the match has anything to do with the overall low residents compensation. Even without the match, the number of applicants and the number of positions are still the same (i.e. supply-demand are the same). The medical education system can still go on working us 80+ hours/week and deciding what salaries they are going to pay us. The control is still on the institution's side because without them, we won't be certified and we can't practice. Some of you are so fixated on "if the programs want me badly, I can bargain with them to get a better deal." It won't be the case. The programs are not going to want one individual so badly that they break their institutional policy on salary to accomodate you. Afterall, there are many more medical grads and FMGs lining up for these positions. The one analogy that I can give would be grocery store workers. The grocery stores are not going to pay one or two individual workers more than others at the same level. They decide on the salary for the workers at different levels, and everyone that are at the same level will get the same salary and benefits. So who bargain for these workers? The union, and that is what we need to get better salaries and compensation, a resident's union, not changing or dissolving the match. A union can collective bargain for all residents at an institution to force them to set the salary at a higher level. That is how we can get the pendulum to swing back to us.

 

[gasman2003]

I liked your comments. I think you and I are saying similar things...I have said from the beginning that the Match might be unchanged as a result of the litigation but that resident unions may be allowed to help improve our financial security.

 

[GeddyLee]

You know...I have to say I think physician-unions is a great idea. Particularly resident unions. The only way to get the pay and benefits we deserve is through unionization.

Look at the airline pilots association. They control their own salary. Every pilot is part of it...and the airlines know they better keep them happy or the airline will quickly fail. In fact, they are so feared, that when they threaten to strike, the president of the US gets involved.

If doctors unionized effectively, we could stop medicare reimbursements from continuing to decline. We could protect ourselves from the evils of HMO's. We could fight to make sure residents aren't overworked. We could do all of this without jeopardizing patient safety.

I'm glad someone mentioned this. There seems to be a failure of medical professionals to figure out how to protect their arses. Forget about petitioning congress and filing law suits. It simply does not work. The way to succeed is unionization.

Hospitals think they own you as a resident, because they know you depend on them to complete your training. When you are out in private practice, medicare and the insurance companies think they own you because you depend on their patients to get paid. It doesn't have to be this way. We just need to band together an regain the ownership of our own practices and our profession.

Problem is...the entire profession is filled with altruists who are pathologically non-greedy. You hear it on these boards all the time. The medical profession seems filled with doctors-in-training who honestly don't care about their salary. It is almost taboo to speak about physician incomes, much less consider it when making a career choice. There's nothing wrong with doing something you love AND being paid well for it. However, if you want to get a lot of evil sneers and flames, talk about doctor incomes...on this forum, around your colleagues....it's almost comical the reactions you get.

 

[zaitoun]

Hi everyone, it's been like 20 yrs since Jung vs. AAMC and match is still alive and thriving. Now residencies are unionizing and demanding better pay, benefits, and work hours/conditions. I feel like another decade or two will pass until something substantial actually happens nationwide. Until then, residents will still be the cheap labor they have always been.

 

[GoSpursGo]

Hi everyone, it's been like 20 yrs since Jung vs. AAMC and match is still alive and thriving. Now residencies are unionizing and demanding better pay, benefits, and work hours/conditions. I feel like another decade or two will pass until something substantial actually happens nationwide. Until then, residents will still be the cheap labor they have always been.

There are plenty of more recent threads that touch on similar issues. I'm going to lock this thread which is now 20 years old.