Does anyone else have this issue with med students?

[Miami_med]

I can't help but wonder if some of it is the clash between rising tuition prices and liability reducing actual student work. As time goes along, it seems like you pay more and more to be less and less important. The money is now enough, that you don't feel any obligation to do work that you don't perceive as being valuable. You've paid good money to be there. That being said, you shouldn't underestimate what is valuable.

I thankfully am at a medical center where students are VERY active in genuine patient care. However, I know many students who essentially sit around for 30 hours at other institutions, and it seems like tuition is just a bit too high for that reward. The excuse of needing to study is just an excuse. My guess is that many people mix this up with the real problem. If the rotations were genuine 100% learning experiences, studying wouldn't help you.

It almost seems like we should eliminate the pretense of eliminating the scut component, drop all tuition for the last two years, and let students learn in exchange for performing a certain amount of required scut work. Then we could stop having these arguments.

Just thinking out loud.

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[sirus_virus]

I can't help but wonder if some of it is the clash between rising tuition prices and liability reducing actual student work. As time goes along, it seems like you pay more and more to be less and less important. The money is now enough, that you don't feel any obligation to do work that you don't perceive as being valuable. You've paid good money to be there. That being said, you shouldn't underestimate what is valuable.

I thankfully am at a medical center where students are VERY active in genuine patient care. However, I know many students who essentially sit around for 30 hours at other institutions, and it seems like tuition is just a bit too high for that reward. The excuse of needing to study is just an excuse. My guess is that many people mix this up with the real problem. If the rotations were genuine 100% learning experiences, studying wouldn't help you.

It almost seems like we should eliminate the pretense of eliminating the scut component, drop all tuition for the last two years, and let students learn in exchange for performing a certain amount of required scut work. Then we could stop having these arguments.
Just thinking out loud.

Don't worry about that happening anytime soon. The more likekly scenerio is residents will soon start paying TUITION. Believe it or not, there are people on Capitol hill calling for that.

 

[Miami_med]

Don't worry about that happening anytime soon. The more likekly scenerio is residents will soon start paying TUITION. Believe it or not, there are people on Capitol hill calling for that.

Wow.

Of course, nothing surprises me on capitol hill.

 

[LADoc00]

Don't worry about that happening anytime soon. The more likekly scenerio is residents will soon start paying TUITION. Believe it or not, there are people on Capitol hill calling for that.

Im gonna need a link on that one..who would residents pay tuition to exactly??? Med schools or the government?

Im not buying it. There are some CRAZY things on the Hill but that smacks of someone spouting off after a 2 martini lunch, a massive line of coke and a furious "session" with a legislative intern in the mens bathroom.

 

[AmoryBlaine]

Don't worry about that happening anytime soon. The more likekly scenerio is residents will soon start paying TUITION. Believe it or not, there are people on Capitol hill calling for that.

I've heard this rumor too. The idea being that now that surgical residents are limited to 80 hours a week they can't get enough done to be cost effective. So the residents will have to pay the hospital to subsidize additional faculty/APNs to cover the extra scut. Apparently working double the "normal" number of hours just isn't enough.

If this ever happens I am moving to Canada and opening a bookstore.

 

[PediBoneDoc]

i don't think there is real talk about paying tuition for residency, but there have been some talk off line about it. recent cuts in GME funding for resident education have created changes in thinking. also some of the increased costs of education (courses and off site clinics) have created problems for some of the less lucrative specialties. there are some significant changes coming down the pipeline in the near future. i am not sure where it will end up. some references of thoughts from another country close by as well is a resident's view on the situation.

i have tried to address some of the concerns i have for the future. i really have no idea of were things are going to end up. the federal cuts in GME funding, i fear, will continue. the incentive to teach will decrease. may be i worry too much. i personally believe that the 80hr work week is not the cause, although many will dispute me on that. i think that it comes down to money and having a single payor source (the federal and state governments) that needs to cut funding. money drives everything and the profit margin is greatly shrinking, eventually they will start looking for other sources of income or cut programs (which i don't think is the answer).

 

[Faebinder]

i don't think there is real talk about paying tuition for residency, but there have been some talk off line about it. recent cuts in GME funding for resident education have created changes in thinking. also some of the increased costs of education (courses and off site clinics) have created problems for some of the less lucrative specialties. there are some significant changes coming down the pipeline in the near future. i am not sure where it will end up. some references of thoughts from another country close by as well is a resident's view on the situation.

i have tried to address some of the concerns i have for the future. i really have no idea of were things are going to end up. the federal cuts in GME funding, i fear, will continue. the incentive to teach will decrease. may be i worry too much. i personally believe that the 80hr work week is not the cause, although many will dispute me on that. i think that it comes down to money and having a single payor source (the federal and state governments) that needs to cut funding. money drives everything and the profit margin is greatly shrinking, eventually they will start looking for other sources of income or cut programs (which i don't think is the answer).

I have argued this with several acadamicians. Everyone is of the solid mindset that residents DO MAKE MONEY for the institution. So the question comes down to this.... Do they make enough money WITHOUT the funding of GME. Do they more than pay for the $120,000 that GME gives the institution each year (from which the resident is paid)? I personally feel the answer is YES! If they work 60 hours each week average, which is the equivilant of 2 mid levels, that alone is $140,000 worth of work per year. So why aren't institutions rushing to have more resident positions? It's cause GME funding is coming from Medicare(medicaid) and is somewhat limited. But why are the hospitals waiting for GME funding if overall the hospital with the residency is making money off the resident? I am not sure there.Why would a money making machine (the hospital) not want to have more residents even if GME doesnt pay for it?

 

[PediBoneDoc]

I have argued this with several acadamicians. Everyone is of the solid mindset that residents DO MAKE MONEY for the institution. So the question comes down to this.... Do they make enough money WITHOUT the funding of GME. Do they more than pay for the $120,000 that GME gives the institution each year (from which the resident is paid)? I personally feel the answer is YES! If they work 60 hours each week average, which is the equivilant of 2 mid levels, that alone is $140,000 worth of work per year. So why aren't institutions rushing to have more resident positions? It's cause GME funding is coming from Medicare(medicaid) and is somewhat limited. But why are the hospitals waiting for GME funding if overall the hospital with the residency is making money off the resident? I am not sure there.Why would a money making machine (the hospital) not want to have more residents even if GME doesnt pay for it?

this is an important question and is hard to put true dollars and cents to how much residents bring into the hospital. residents salary and other benefits are covered by DGME and the increase cost of having residents is covered by IME, the number varies based on a fancy formula. the money that a hospital gains because of having residents is a number that you can not put direct funds on. i will say that in order to be a level 1 trauma center, you must have a number of subspecialties (neurosurg, ortho, general, etc) and having residents makes coving those services easier and being level 1 brings funds into the hospital. patient care that is given on the IM and PEDs services which rely on residents and can be billed (from my limited understanding of billing in primary care) by the physician and hospital. also, ancillary used by the residents can not be quantified, but definitely bring in money to the institution.

because the money is not all in one bucket the question is who will pay for the resident. will it be the university, group, department, service, or hospital? the money is not free flowing and not all receive major benefits by having the resident.

with midlevel providers, their income is easier to track because they can bill independently from the physician and hospital. their income based on patients seen in clinic and on the wards can be tract. if they are utilized appropriately, they can cover their salary or actually make money. with the changes in resident hours, there has been an increase of utilization of these midlevel providers.

to your question on hospitals funding resident position, it is happening. it is slow and is based on how solvent a hospital or department is. for a department, in general you will not see an increase in the bottom line with having a resident (because you can not directly bill), but will see in increase with a PA or NP.

i think you bring up an important question that is being addressed on multiple levels from the AAMC to specialty boards. i tried to bring up some of these concerns, but this is a very big issue that has brought problems on many different levels. this is a big picture issue.

 

[Faebinder]

this is an important question and is hard to put true dollars and cents to how much residents bring into the hospital. residents salary and other benefits are covered by DGME and the increase cost of having residents is covered by IME, the number varies based on a fancy formula. the money that a hospital gains because of having residents is a number that you can not put direct funds on. i will say that in order to be a level 1 trauma center, you must have a number of subspecialties (neurosurg, ortho, general, etc) and having residents makes coving those services easier and being level 1 brings funds into the hospital. patient care that is given on the IM and PEDs services which rely on residents and can be billed (from my limited understanding of billing in primary care) by the physician and hospital. also, ancillary used by the residents can not be quantified, but definitely bring in money to the institution.

because the money is not all in one bucket the question is who will pay for the resident. will it be the university, group, department, service, or hospital? the money is not free flowing and not all receive major benefits by having the resident.

with midlevel providers, their income is easier to track because they can bill independently from the physician and hospital. their income based on patients seen in clinic and on the wards can be tract. if they are utilized appropriately, they can cover their salary or actually make money. with the changes in resident hours, there has been an increase of utilization of these midlevel providers.

to your question on hospitals funding resident position, it is happening. it is slow and is based on how solvent a hospital or department is. for a department, in general you will not see an increase in the bottom line with having a resident (because you can not directly bill), but will see in increase with a PA or NP.

i think you bring up an important question that is being addressed on multiple levels from the AAMC to specialty boards. i tried to bring up some of these concerns, but this is a very big issue that has brought problems on many different levels. this is a big picture issue.

At this point we are off the main thread...

I am just sick of the fancy formula claim that residents cost more than they are worth. You get the academicians who will tell you they are worth their weight in gold... but then you get the adminstrators who will tell you they cost too much and we should just get rid of them. If hospitals need a way to track how much is a resident worth, then they need to modify the system to do it. That should add efficiency and ability to tighten/widen up funds.

I feel that when something like the above is proposed, you generally need some publications to back you up when telling this to an adminstrator. Academic medicine is getting rusty and old when it comes to this sort of thing, they prefer to discover some cytokin or a new cancer antigen.

 

[tatabox80]

Just having graduated from med school myself, I'm looking at this thread and thinking back to early in my 3rd year of med school. I had NO CLUE as to what was going on. I wonder if the residents who are posting about these "lazy med students" have considered that they might not know what to do, and need things explained to them because they haven't been working in the hospital as a resident/med student for 2+ years. If you knew how to do everything as a 3rd year medical student, I salute you because you are far more superior than I. However, I can imagine that everyone here was confused and felt lost during the early part of their clinical education and appreciated it when residents actually told them what to do. Also, I can empathize with the "scutwork isn't on the shelfcopy" comment because really....getting coffee and food for your resident really isn't all that beneficial to a medical student's education. There are lazy med students I'm not going to deny that, however, seeing someone sitting around may not necessarily be a sign of laziness, but of confusion...so I think rather than posting a negative post about them on student doctor, maybe a wiser choice would be to approach them and help them out a bit.

 

[Smurfette]

Just having graduated from med school myself, I'm looking at this thread and thinking back to early in my 3rd year of med school. I had NO CLUE as to what was going on. I wonder if the residents who are posting about these "lazy med students" have considered that they might not know what to do, and need things explained to them because they haven't been working in the hospital as a resident/med student for 2+ years. If you knew how to do everything as a 3rd year medical student, I salute you because you are far more superior than I. However, I can imagine that everyone here was confused and felt lost during the early part of their clinical education and appreciated it when residents actually told them what to do. Also, I can empathize with the "scutwork isn't on the shelfcopy" comment because really....getting coffee and food for your resident really isn't all that beneficial to a medical student's education. There are lazy med students I'm not going to deny that, however, seeing someone sitting around may not necessarily be a sign of laziness, but of confusion...so I think rather than posting a negative post about them on student doctor, maybe a wiser choice would be to approach them and help them out a bit.

I know for myself, I don't assume anything with 3rd year med students. I know they don't know how things work, etc., especially at the beginning of the year. It is once they are told (usually more than once) what the expectations are and what to do in explicit detail and just don't seem to care or put in effort or have attitudes that I start having "issues". If I ask you to go see a patient, go see the patient...you might learn something and you need practice. This is what 3rd year is for....to learn how to interact with and examine patients and evaluate their problems. If I send you to the OR for a case, I expect you to go there for the case. If you have other commitments (lecture, an appt, whatever), I expect you to let me know when you need to leave and when you'll be back. If something unexpected happens that requires you to leave, I expect that you will let me know and not just leave without telling a soul. I don't think these are unreasonable expectations, since in any job you have, you need to do what your supervisor assigns you to do, be at whatever meetings you are supposed to attend and call in sick/ask to leave/let your boss know your whereabouts as is appropriate.

I don't have students fetch me coffee or food, and if i EVER saw another resident that I work with do that I would speak up, because that is not appropriate. I do know that it happens, but I personally never have seen it firsthand (although this is probably pretty institution-dependent since this kind of behavior tends to breed more future residents who will do it to their med students). As a side note, if a student offers to grab them something and the resident then gives them money to do so, then that is at the student's own discretion and certainly is not something the student should then complain about, if the student offered.

 

[yaah]

Unfortunately, there are too many med students with a sense of entitlement - that the world owes them a favor, that everyone (including patients) exists to serve their needs, etc. However, there are also too many residents that this is also true for. It is unfortunate that so many people go into this field (including the excessively long training period) and aren't fully committed to it. They want to be "part time" before they even finish training. They get upset when someone comes in 5 minutes before they are "off the clock." They do the bare minimum during residency and don't work harder to increase their knowledge base and experience. Medicine is not a normal "job." You don't punch in and out and leave everything when you head out the door. If you treat it with that attitude you are likely to be unsuccessful.

 

[LADoc00]

LMAO@no resident salary!

If I was a nonpaid resident I would show up in shorts at around noon scratching my nuts after having thrown my pager into a fountain outside the hospital.

 

[GuP]

LMAO@no resident salary!

If I was a nonpaid resident I would show up in shorts at around noon scratching my nuts after having thrown my pager into a fountain outside the hospital.

This would be grand rounds if residents didn't get paid: