Nurses making more than docs at UCSF County

[Hernandez]

I am just a pre-med, so my opinion is worthless. But...I don't get why you guys (residents I presume) go on these boards and rant all day. Who do you think will listen to that? Why don't you actually DO something about it, so in a few years (when I get to have my fun) it will be better. Why do you not do anything...??? I don't get this??

why thank you for pointing out the obvious, it obviously never crossed my mind that ranting on the internet would not change anything.

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[Hernandez]

why thank you for pointing out the obvious, it obviously never crossed my mind that ranting on the internet would not change anything.

Ok, that was overly sarcastic. In my home state, I stayed in touch with my state level representatives and tried to stay on top of the bills pertinent to reimbursement, if the topic comes up; I try to dispel the myth that I'll be rich and enlighten them as to the status of my debt level to declining salaries. But beyond a huge upheaval by residents, I do not see anything being done about the salary of residents.

 

[mgdsh]

I am just a pre-med, so my opinion is worthless. But...I don't get why you guys (residents I presume) go on these boards and rant all day. Who do you think will listen to that? Why don't you actually DO something about it, so in a few years (when I get to have my fun) it will be better. Why do you not do anything...??? I don't get this??

I do believe we're doing more than just ranting. We're exchanging ideas in an area where more residents / doctors will be able to read/listen to what we're talking about.

A decent portion of this thread was also directed towards another doctor/resident who felt any type of reform was unnecessary.

Discussions like this thread are whats necessary for us to work together and not only get other doctors/residents more interested in this but to show some of them (that still don't really know) what the issues are and that something needs to be done.

 

[E Dubble]

I am just a pre-med, so my opinion is worthless. But...I don't get why you guys (residents I presume) go on these boards and rant all day. Who do you think will listen to that? Why don't you actually DO something about it, so in a few years (when I get to have my fun) it will be better. Why do you not do anything...??? I don't get this??

Because we are working at least 70-80 hrs per week. Nurses, PAs dont work this much and thus have way more time to fight for more money.

 

[sirus_virus]

I always like to read the 20 questions thing on the home page of SDN. I found this guys answer pretty interesting

Q:Are you satisfied with your income?

A: For the time being, I feel like the reimbursement is commensurate with the level of complexity, skill requirement, and risk in the field. There is a continuous and exhausting downward pressure on reimbursement by third-party payers and managed care organizations. Physicians need to be involved and at the table justifying what they do.

To me, that translates to: "HELL NO, I need more money for this crap".

 

[danielmd06]

What are the arguments to the public and other proffesions are you guys going to give to reverse the declining trend in your salary? The current ones that we have just won't cut it.

Whoa there, cowboy.

Healthcare is considered by many to be a privilege. Ever see how grateful the WWII veterans are in VA hospitals? They represent a fundamental difference in current American thoughts and the gross sense of entitlement that too many people have today, of course. Perhaps it was something to do with that...what was it's name? Oh yeah, the Great Depression.

Nurses and other healthcare workers have seen progressive improvements in their salaries...unlike doctors. Not to mention virtually every other profession in this country. Meanwhile, inflation keeps going up, the costs of college and medical school continue to rise, and the lengths of certain residencies get longer.

If you think that vet school is as competitive as med school then you need to lay off the crack.

We actually have the equivalent of socialized healthcare now...it's called Medicare and Medicaid. Think it really works so much better?

 

[Hernandez]

Whoa there, cowboy.

Healthcare is considered by many to be a privilege. Ever see how grateful the WWII veterans are in VA hospitals? They represent a fundamental difference in current American thoughts and the gross sense of entitlement that too many people have today, of course.

I've got to admit, the WWII vets are some of my favorite pts. I know for a fact that when they complain, odds are it's legitimate and they're downplaying it substantially. Those guys know what it's like to have it rough. Not to mention, in my experience, they tend to be hard working people.

 

[The_Sensei]

I am just a pre-med, so my opinion is worthless. But...I don't get why you guys (residents I presume) go on these boards and rant all day. Who do you think will listen to that? Why don't you actually DO something about it, so in a few years (when I get to have my fun) it will be better. Why do you not do anything...??? I don't get this??

You're right........your opinion IS worthless.

 

[MacGyver]

Its only going to get worse as we continue to allow these "non-doctors" to stick their greedy fingers in the healthcare pie. Its already started with NPs and PAs being allowed to independently bill Medicaid/Medicare.

Eventually homeopaths and naturopaths and all sorts of quacks are going to lobby to be included in Medicare/Medicaid reimbursement. When that happens (and it WILL happen, its already happened in the UK) then doctor salaries will go down even further because the money to pay providers all comes out of one pie.

When you pay quacks like naturopaths out of federal funding for Medicare, it means that reimbursement to legitimate family practice docs and the rest of us will go down to compensate for their unwanted intrusion.

 

[MDPhoDollas]

I am just a pre-med, so my opinion is worthless. But...I don't get why you guys (residents I presume) go on these boards and rant all day. Who do you think will listen to that? Why don't you actually DO something about it, so in a few years (when I get to have my fun) it will be better. Why do you not do anything...??? I don't get this??

It is only in recent years that medical education has become merit based to a respectable degree. still, a large percentage of those in medicine are there because it was literally the easiest thing they could have done with their life. only once this element is diluted more (if even possible) will there be a large enough majority of people who care to stand up for what is right. those who were born with daddy's and all daddy's colleagues' letters of recommendation signed and ready to go really do not depend on their salaries and will be damned if they are going to help hard working americans achieve such wealth.

 

[Stimulate]

Residents do need to take more initiative in negotiating higher salaries. I do think the Match system is OK in determining where you will do your residency, however, I don't agree with the methods that programs use to fix our salaries. There should be a bargaining process with the housestaff association. Key in this bargaining process should be what the hospitals are paying mid-level providers like PA-C and NPs. Residents (many of whom are licensed physicians) should be making at least what these midlevel providers earn. PA-Cs and NPs contribute about the same effort and work product that a resident contributes (in fact residents work many more hours per week than midlevels as well). It is legal for residents to form unions. In fact there is a large national union already (http://www.cirseiu.org/). I just found them by google so I don't know much about this union but clearly there are housestaff unions already in place. I don't have a problem with nurses making good salaries in areas where there is a high-cost of living however, residents should be making comparable if not higher income.

Physicians are becoming left behind in the salary-growth because we don't have the national negotiating power that hospitals and drug companies have. These hospital associations and drug companies have an enormous amount of power in the negotiating process. I am amazed that every single physician isn't an AMA member. Last data I saw from like 1998 showed only 1 in 6 physicians were in the AMA. No wonder our rights and incomes are eroding exponentially.

Another thing I can't believe is that doctors are stupid enough to buy into this "Pay for Performance" concept. We are sooo greedy that we are inviting the government to audit our medical practices so that we can get an extra 1 percent bonus each year for meeting the government's "quality" criteria. How many professions out there are inviting the government to audit their practices? The absolute last thing I want is to have the government reviewing my charts for this data. They can keep their 1 percent!

We INVITE government interference in our practices, we allow them to dictate our payments, and the majority of us don't care enough about it to even be members of our advocacy group (the AMA). How many drug companies and hospitals are sitting by without lobbying their representatives? Yet we are apathetic and wonder why things are getting worse.

 

[sirus_virus]

Residents do need to take more initiative in negotiating higher salaries. I do think the Match system is OK in determining where you will do your residency, however, I don't agree with the methods that programs use to fix our salaries. There should be a bargaining process with the housestaff association. Key in this bargaining process should be what the hospitals are paying mid-level providers like PA-C and NPs. Residents (many of whom are licensed physicians) should be making at least what these midlevel providers earn. PA-Cs and NPs contribute about the same effort and work product that a resident contributes (in fact residents work many more hours per week than midlevels as well). It is legal for residents to form unions. In fact there is a large national union already (http://www.cirseiu.org/). I just found them by google so I don't know much about this union but clearly there are housestaff unions already in place. I don't have a problem with nurses making good salaries in areas where there is a high-cost of living however, residents should be making comparable if not higher income.

Physicians are becoming left behind in the salary-growth because we don't have the national negotiating power that hospitals and drug companies have. These hospital associations and drug companies have an enormous amount of power in the negotiating process. I am amazed that every single physician isn't an AMA member. Last data I saw from like 1998 showed only 1 in 6 physicians were in the AMA. No wonder our rights and incomes are eroding exponentially.

Another thing I can't believe is that doctors are stupid enough to buy into this "Pay for Performance" concept. We are sooo greedy that we are inviting the government to audit our medical practices so that we can get an extra 1 percent bonus each year for meeting the government's "quality" criteria. How many professions out there are inviting the government to audit their practices? The absolute last thing I want is to have the government reviewing my charts for this data. They can keep their 1 percent!

We INVITE government interference in our practices, we allow them to dictate our payments, and the majority of us don't care enough about it to even be members of our advocacy group (the AMA). How many drug companies and hospitals are sitting by without lobbying their representatives? Yet we are apathetic and wonder why things are getting worse.

The AMA needs to be flooded with members that really care about physician interests.

 

[core0]

The AMA needs to be flooded with members that really care about physician interests.

Originally Posted by Stimulate
Key in this bargaining process should be what the hospitals are paying mid-level providers like PA-C and NPs. Residents (many of whom are licensed physicians) should be making at least what these midlevel providers earn. PA-Cs and NPs contribute about the same effort and work product that a resident contributes (in fact residents work many more hours per week than midlevels as well). .

While I would agree that residents are vastly underpaid for what they do, there is one major difference between the resident and NPPs. NPPs are specifically allowed to bill medicare and programs are specifically prohibited from billing for resident services. Therefore NPPs bring in revenue that far exceeds their salaries. If you want to change that you would need to change the rules to allow programs to bill for resident services or for Medicare to allot more money for resident training.

David Carpenter, PA-C

 

[Stimulate]

While I would agree that residents are vastly underpaid for what they do, there is one major difference between the resident and NPPs. NPPs are specifically allowed to bill medicare and programs are specifically prohibited from billing for resident services. Therefore NPPs bring in revenue that far exceeds their salaries. If you want to change that you would need to change the rules to allow programs to bill for resident services or for Medicare to allot more money for resident training.

David Carpenter, PA-C

I am not too concerned with the hospital being able to get reimbursed for my services because the hospitals recieve approximately $120,000/year/resident from Medicare. So if you estimate a residents salary and benefits to comprise $55,000/year there is still a lot of money left over.

Further, there are hundreds of employees in every hospital that do not bill for their services directly yet hospitals still stay in business. This is why hospitals charge for inpatient services in addition to provider services, and they use these funds to cover their overhead (RNs, hospital-based PAs/NPs).

A high percentage of inpatient care is paid based on a DRG wherein the hospital gets "x" amount of dollars based on the diagnosis code for that admission. In this scenario there is no real financial difference between care provided by a hospital-based PA-C/NP or a resident physician. There is a cost to providing patient-care and for now hospitals have cheap labor (residents) who are stuck in a position where there is no negotiation (at least for now).

As an aside, anesthesiology residents are the only speciality of residents who have billing codes and the department bills insurance/medicare for their services (in addition to the attendings fee).

If hospitals wanted to bill directly for resident services then medicare would probably stop paying the $120,000/year. However, that doesn't necessarily prohibit hospitals from billing other payors for resident services provided the residents had a valid state medical license. I wonder if this has been tried in the past?

 

[core0]

I am not too concerned with the hospital being able to get reimbursed for my services because the hospitals recieve approximately $120,000/year/resident from Medicare. So if you estimate a residents salary and benefits to comprise $55,000/year there is still a lot of money left over.

I think you underestimate the cost of benefits but from what I have heard a hospital basically breaks even. When you figure lost production due to rounding it probably costs money. I would let others that are more involved in this comment.

Further, there are hundreds of employees in every hospital that do not bill for their services directly yet hospitals still stay in business. This is why hospitals charge for inpatient services in addition to provider services, and they use these funds to cover their overhead (RNs, hospital-based PAs/NPs).

A high percentage of inpatient care is paid based on a DRG wherein the hospital gets "x" amount of dollars based on the diagnosis code for that admission. In this scenario there is no real financial difference between care provided by a hospital-based PA-C/NP or a resident physician. There is a cost to providing patient-care and for now hospitals have cheap labor (residents) who are stuck in a position where there is no negotiation (at least for now).

All inpatient care is paid for under a DRG basis. That pays for the hospital stay. It covers the room, the nursing, the food the drugs etc. For medicare (and I will limit to this since it covers resident education) there are two parts. Part A whic covers hospital and long term care and Part B which covers physician services. From CMS:
Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Certain conditions must be met to get these benefits.
Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

So Physician, PA and NP services are billed under part B and reimbursed based on the CPT code of the visit. Medicare specifically prohibits billing for resident services and states that the physician must be present for a substantial portion of the care. So NPs and PAs bring in income to the facility. There was older legislation that allowed NP services to be billed under part A but that was changed some time ago. You can bill the portion of the NP/PA services devoted to administration under part A but not patient services.

This gets more obtuse when you have a substantial population that does not have insurance. In this case the reimbursement may not support a PA or NP much less a physician. This is the place where a residents salary suplliment makes a difference. It is also not a place where you can probably negotiate a higher salary.



As an aside, anesthesiology residents are the only speciality of residents who have billing codes and the department bills insurance/medicare for their services (in addition to the attendings fee).

I understand that anesthesia billing is different (hence the CRNAs wanting a piece of this). You can also bill for certain fellows if I understand correctly.

If hospitals wanted to bill directly for resident services then medicare would probably stop paying the $120,000/year. However, that doesn't necessarily prohibit hospitals from billing other payors for resident services provided the residents had a valid state medical license. I wonder if this has been tried in the past?

Most hospitals are meant to run on medicare plus private insurance. I doubt this would work and there is legislation that would prohibit you from cherry picking the non medicare cases. While it is not uncommon for private practice to not accept medicare, I cannot think of a hospital off hand that does not. I do not think it would be a viable business model. Also for most insurances to be credentialled you need to have completed a residency and have an unrestricted medical license. On the other hand residents moonlight so there must be some billing mechanism.

This is tremendously complex area and CMS has made it so. The proper mechanism for change is probably to lobby CMS for changing the billing structure and reimbursement.

David Carpenter, PA-C

 

[Miami_med]

Most hospitals are meant to run on medicare plus private insurance. I doubt this would work and there is legislation that would prohibit you from cherry picking the non medicare cases. While it is not uncommon for private practice to not accept medicare, I cannot think of a hospital off hand that does not. I do not think it would be a viable business model. Also for most insurances to be credentialled you need to have completed a residency and have an unrestricted medical license. On the other hand residents moonlight so there must be some billing mechanism.

This is tremendously complex area and CMS has made it so. The proper mechanism for change is probably to lobby CMS for changing the billing structure and reimbursement.

David Carpenter, PA-C

Finishing a residency gives you board certification, but isn't necessary to become licensed. Different states require 1-3 Post grad years for licensing, with the majority being 1 year. There is no law that you can't bill without board certification.

 

[Faebinder]

Why would the teaching attendings allow the residents to bill instead of them? They would not make even near the money they would working in private. Residents billing wont be okay with the teaching attendings.

We need another solution for the residents... These are two separate issues.

 

[PreMedDocMD]

You guys should go over to a law forum and completely trash them. I am voting for that. Reading these articles and posts on the healthcare crisis makes me both scared for my future, but also ver angry at lawyers and the general ignorance of the public. It also makes me more eager to become a physician so I can finally do something about this.

 

[toxic-megacolon]

Nurses are overworked and underpaid as well yet they just deal with it.

I don't know what nurses you know. At every hospital I've worked at, nurses work 3 or 4 days a week, and pull in 40-60K per year.

Having a 4 day weekend EVERY WEEK = overworked?
Riiight....

 

[DarksideAllstar]

I don't know what nurses you know. At every hospital I've worked at, nurses work 3 or 4 days a week, and pull in 40-60K per year.

Having a 4 day weekend EVERY WEEK = overworked?
Riiight....

My best friend's wife is a nurse, 2 years out. She is making something like 65K this year and if she gets charge nurse she will get bumped to 80K . That's with a BS and working 3 12 hr shifts per week.

 

[Tired]

My best friend's wife is a nurse, 2 years out. She is making something like 65K this year and if she gets charge nurse she will get bumped to 80K . That's with a BS and working 3 12 hr shifts per week.

As I've mentioned on other forums, my wife is an RN with an associates' degree. She made over 80k last year doing three 12hr shifts a week. That's more than I make, even as a military resident (paid as an O3 w/<2y in).

The flip side is that she will most likely never make much more than this, unless she starts doing overtime (which she'll never do). The downside of money in nursing is that, while you starting paycheck seems obscenely high, it tops out relatively quickly, and short of working more hours, there's not much you can do to pull it up.

 

[DarksideAllstar]

As I've mentioned on other forums, my wife is an RN with an associates' degree. She made over 80k last year doing three 12hr shifts a week. That's more than I make, even as a military resident (paid as an O3 w/<2y in).

The flip side is that she will most likely never make much more than this, unless she starts doing overtime (which she'll never do). The downside of money in nursing is that, while you starting paycheck seems obscenely high, it tops out relatively quickly, and short of working more hours, there's not much you can do to pull it up.

She can top out all she wants. Making that much money early on (with compound interest) is a good gig.

 

[MDPhoDollas]

short of working more hours, there's not much you can do to pull it up.

One can become a CRNA. That pulls up a nurses salary significantly and swiftly.

 

[notherenorthere]

Are you all kidding? You think healthcare is financially going in a direction where medicare will directly reimburse billed hours from residents?

The obvious reason PAs and NPs are having jobs is because it has been shown a cheaper delivery model in many instances. If it cost more money, they would not be there. !!

It seems very odd to me that these conversations between you all seem to deviate into salaries and how to increase doctor's salaries, as well as showing an apparent disregard to those you consider "lower professions" making more money than certain doctors. I mean...you all did not go into medicine for the salary alone, right? There is a slim chance doctor's salaries are going to do anything but decline more (a little). The healthcare system as it stands will not sustain itself much longer.

Lastly, have any of you realized a large reason patients become inpatient? It's for the nursing care (and other ancillary care). I don't understand why anyone would put down someone for making a good salary. Who cares?

Residents are still under training - it costs a lot of money to have a residency program in hospitals. Residents are not profit entities and never will be. It's like a law clerk for a judge as a law grad - these jobs don't pay for the amount of work that goes into them.

I mean if you want big money, you should have gone into IBanking or Law (new law grads at big firms are starting at 160K in NYC and other big cities) Not Medicine!!!

 

[djavid]

Just out of curiosity, what would you do about it when you are a physician?

You guys should go over to a law forum and completely trash them. I am voting for that. Reading these articles and posts on the healthcare crisis makes me both scared for my future, but also ver angry at lawyers and the general ignorance of the public. It also makes me more eager to become a physician so I can finally do something about this.

 

[Hernandez]

Lastly, have any of you realized a large reason patients become inpatient? It's for the nursing care (and other ancillary care). I don't understand why anyone would put down someone for making a good salary. Who cares?

Personally, it has nothing to do with them making a good salary. It's more jealousy that I'm working my ass off, being paid chump change, and that most of them still don't get it that I've been up for 24 hours straight and still have 6 more to go.

Residents are still under training - it costs a lot of money to have a residency program in hospitals. Residents are not profit entities and never will be.

I have a hard time buying this. Does anyone have any proof that Residents loose money for Hospitals? Because I know that they get ~$110k per resident, so a little over half of that goes towards our salary & benefits. AND the hospital gets reimbursed at a higher rate from Medicare/caid because they are a teaching institution. So just how does that turn into a negative balance?

 

[Tired]

Does anyone have any proof that Residents loose money for Hospitals? Because I know that they get ~$110k per resident, so a little over half of that goes towards our salary & benefits. AND the hospital gets reimbursed at a higher rate from Medicare/caid because they are a teaching institution. So just how does that turn into a negative balance?

The argument that residents are a "money-losing" entity is total crap. This has been dealt with better by others, but anyone with a modicum of common sense will recognize that paying a resident 40k/yr to do a job that would otherwise require an attending making 150k/yr definitely generates money.

 

[raidermedic]

It seems very odd to me that these conversations between you all seem to deviate into salaries and how to increase doctor's salaries, as well as showing an apparent disregard to those you consider "lower professions" making more money than certain doctors. I mean...you all did not go into medicine for the salary alone, right?

I don't understand why anyone would put down someone for making a good salary. Who cares?

Um my thoughts exactly........

Residents are still under training - it costs a lot of money to have a residency program in hospitals. Residents are not profit entities and never will be.

That training line is utter BS. The house officer in IM basically serves the same purpose as any PA or NP working the floor. Anyone who has finished their intern year could function at the same level as a midlevel. So why shouldn't he be reimbursed like one?
And like others have mentioned how can the hospital lose money when they are taking in 120K and only dealing out 50K to the residents? Does it really cost 70K a year to "teach" one resident? Not only that but a single resident puts in about twice as much work in a week than a PA or NP. So theres another 160-200K a year for the hospital. 270K a year to train a resident?

 

[Faebinder]

Residents are still under training - it costs a lot of money to have a residency program in hospitals. Residents are not profit entities and never will be. It's like a law clerk for a judge as a law grad - these jobs don't pay for the amount of work that goes into them.

You are hereby labeled "Misinformed". Next thing you know, you will be wanting residents to do it for free like in 1985. There are more unmatched people now and medicare/medicaid will happily cut their part out, so it's definitely possible, don't start that wishful thinking.

 

[notherenorthere]

You're right, I am wrong. I was thinking about other things when I posted my response. However, I agree with you all and think residents should be paid more. Anyway, the way to go about it is not to show "how much we went through" in training as one person said much earlier on this thread. You have to show instead why residents are so valuable to hospitals. The profit margin, especially for surgical residents, is not as large as you guys think, though I agree that residents generally earn some revenue for hospitals - it's not the veritable cash cow you all say - if so, then why were so many hospitals worried about hours cap that went into effect a while back?? Think about it for a second. Also, you guys are not considering how much benefits cost - are you all regular employees? Do you pay medicare taxes? Get insurance - health, mal etc...these things are not free. Couple in the time attendings spend rounding and doing other things they could do in a fraction of the time on their own, etc.....but I agree residents are used and it should be an antitrust issue because it's very anticompetitive.

Anyway, my main point on chiming in on this thread was that it's a waste of time for you to hate on other people's salaries...just be happy for them. It's obvious you're jealous and maybe bitter that you chose medicine. I know many of you believe you're better because of your investment, both financial and time-wise, but no one cares. This world is based on "how much is in my pocket?" And the pursestrings in healthcare are controlled by MBAs, not MDs. Take control back....but keep in mind the direction healthcare is going into, and the evidence that NPs and PAs are profitable for hospitals as opposed to MDs, and that a lower nurseatient ratio results in lower costs over time.

Good luck guys. I respect all doctors...

 

[Hernandez]

- it's not the veritable cash cow you all say - if so, then why were so many hospitals worried about hours cap that went into effect a while back?? Think about it for a second.

Or perhaps they were worried because they would have to hire someone else at an actual salary to do the job we were doing for peanuts?

Also, you guys are not considering how much benefits cost - are you all regular employees? Do you pay medicare taxes? Get insurance - health, mal etc...these things are not free.

I pay my own health insurance, and really the only benefits I'm getting from the hospital is......hang on it'll come to me....... I've got nothing. Do any residencies match any 401k/403b savings? I doubt it.

Couple in the time attendings spend rounding and doing other things they could do in a fraction of the time on their own, etc....

I won't comment on this one. But as mentioned above, think for a moment about all the free house officer work residents and interns do. Even 2nd year residents make $50/hour moonlighting. so if you figure with that number how much money a year do you think residents save the hospital by not paying someone else to do it?

 

[notherenorthere]

Hernandez, you pay for your own health insurance? So is it a crap insurance that grad students get, or do you pay the entire premium for a decent insurance? if latter, how can you afford it? Seriously? Are you sure you don't pay a bit each week for health insurance? for instance, many hospital employees pay 30 or 40 out of their check each week for insurances. Malpractice? Employers also pay the same amount of medicare taxes that employees pay? So basically add 6% to your salary.

At any rate, you're arguing with the wrong person (me) since I mentioned a couple of times in my post that I think residents should be paid more. But look at reality. Doctors are notoriously bad at understanding finance and economics. I don't wonder why, reading through these posts.

It seems to be more profitable to go to school and become a nurse or pharmacist. Nurses won't make more than doctors - but like I mentioned, they can work overtime with agencies or in their own facilities. Where I live, if a nurse with 3 years of experience works, say has a 36 hour a week (3 days) regular job and works 16 hours for a total of 5 days and 52 hours at an agency, she'll make about 92,000...and that's no overhead costs, etc.

A nurse with a straight agency job can work 40 hours a week and make 80K...critical care that amount becomes 94,000 working 40...

Maybe there is something wrong with this picture, but it is reality. Good Luck.

 

[raidermedic]

Think about it for a second. Also, you guys are not considering how much benefits cost - are you all regular employees? Do you pay medicare taxes? Get insurance - health, mal etc...these things are not free.

The total package comes out to about 58K in my state. Thats with a base salary around 43K and all benefits (including med mal) paid.

Couple in the time attendings spend rounding and doing other things they could do in a fraction of the time on their own, etc.....

Attendings round in a fraction of the time thanks to residents and med students. Private attendings have residents and students see all their patients starting around 5-6 AM. Then come in and sign off on all of them in about an hour.

Anyway, my main point on chiming in on this thread was that it's a waste of time for you to hate on other people's salaries...just be happy for them.

Thats all we ask for. But any time we want to talk about salary some snarky person comes in and starts spouting off "Well you didn't go into this for the money did you?" I've never heard this once said to nurses who were threatening to or actually did strike. Nor to any PAs. But when it comes to physicians especially residents no one even wants to entertain the idea of them being paid better.

 

[Hernandez]

Hernandez, you pay for your own health insurance? So is it a crap insurance that grad students get, or do you pay the entire premium for a decent insurance? if latter, how can you afford it? Seriously? Are you sure you don't pay a bit each week for health insurance? for instance, many hospital employees pay 30 or 40 out of their check each week for insurances. Malpractice? Employers also pay the same amount of medicare taxes that employees pay? So basically add 6% to your salary.

FICA, taxes, insurance, life insurance, etc, etc, etc. It all comes out of my "paycheck". Everything except the malpractice insurance, comes out of my "salary." And I'm sure the other 70K dollars the hospital is given that covers me more than covers malpractice insurance. The insurance is decent insurance, but I'm still paying a rather large chunk of change on a yearly basis.

Doctors are notoriously bad at understanding finance and economics. I don't wonder why, reading through these posts.

I have a fair grasp on finances, and if there is something I don't understand. My wife has a MBA and has plenty of business background and I can just ask her.

It seems to be more profitable to go to school and become a nurse or pharmacist.

I personally would not be happy taking orders and I did not go into medicine strictly for the money. But at the same time, I did not bust my butt to be paid a smidgen more than someone who went to 2 years of vocational school.

 

[notherenorthere]

Well, not to be continually snarky, but I hope most MDs did not go into it for the money. Far too much responsibility and hassle, not to mention education.

The market is what it is. Lawyers can make huge salaries, right? Especially if they are in a firm that represents big corporations. however, an attorney working for the poor providing essential legal services makes 35K-50K. Education is not the sole determinant of what one will be paid. So, your rude comment about being paid a smidgen more than a 2 yr grad doesn't really mean anything...like it or not, the market is paying those people because they are needed and there is a low supply...end of story. Besides, many nurses have 4 yr degrees, but that's beside the point for these purposes.

Anyway, stop attacking my posts. I said residents should make more even though I have nothing to personally gain from such an income increase. I just think they are veritable slaves for hospitals and that's wrong and very anti-free market.

Oh and one other thing - nurses do a lot more than "take orders." In fact, that very phrase brings to mind an antiquated way of looking at medicine. When you're out in the trenches long enough, you might finally realize nurses and therapists have their own practice. Nurses look at orders as patient orders, not orders to be carried out as commanded by an MD. When I was a nurse, I would not carry out an order unless I felt comfortable with it - so I'd ask more questions or page the attending. Perhaps this made residents hate me, but in reality, they should be glad I was such a conscientious nurse and trying my best to do right by the patient. If this made me seem "difficult" to work with in the eyes of a resident, then that resident needed more perspective. Anyway, enough about that. Besides, I got along with residents anyway - Harvard residents are awesome - hardly any superiority complexes compared to lesser ranked hospitals. They are down to earth, they know they have nothing to prove. I love the community Mass. General had in its staff.

I hope residents are treated more fairly in the future - God knows they deserve a lot more credit for their hell schedules.

 

[core0]

FICA, taxes, insurance, life insurance, etc, etc, etc. It all comes out of my "paycheck". Everything except the malpractice insurance, comes out of my "salary." And I'm sure the other 70K dollars the hospital is given that covers me more than covers malpractice insurance. The insurance is decent insurance, but I'm still paying a rather large chunk of change on a yearly basis.



I have a fair grasp on finances, and if there is something I don't understand. My wife has a MBA and has plenty of business background and I can just ask her.



I personally would not be happy taking orders and I did not go into medicine strictly for the money. But at the same time, I did not bust my butt to be paid a smidgen more than someone who went to 2 years of vocational school.

If you are looking for analysis here is some. This particular study shows a net loss per resident:
http://www.stfm.org/fmhub/fm2006/June/Judith408.pdf

Here is a study from 95. At that time programs made a little money from FM and took huge losses from surgery:
http://gateway.nlm.nih.gov/MeetingAbstracts/102215440.html

Also note that resident costs decrease as the program is larger as evidenced here:
http://archinte.ama-assn.org/cgi/content/abstract/161/5/760

Bottom line this is a very complex process that is not easily fixable in the current economic climate.

David Carpenter, PA-C

 

[notherenorthere]

I knew surgical residents caused losses in the hospital. I am glad someone found articles shedding some light on this, it's very interesting to me since I am moving into an area of healthcare finance now. Anyway, I decided it was easier to agree with the residents, here at least. Although there is no way anyone can reasonably argue surgical residents make money for hospitals. Medical residents may in smaller programs. Anyway, enough about all of this. I'd like to see more cites of articles in case you run across anything. It's really hard to get good data on this topic. The info I shared was anecdotal (i.e. the thoracic chief at one hospital just happened to mention to me how much money surgical residents cost, etc).

 

[Faebinder]

you do realize that these articles were written in 1995 about numbers obtained in 1990. 17 years later, the cost of medicine has changed termendously. It still doesn't take into account the substitute for the residents and how much worse they would cost. (Yes residents might lower productivity of attendings per patient, but now attendings can handle more patients).

 

[notherenorthere]

you do realize that these articles were written in 1995 about numbers obtained in 1990. 17 years later, the cost of medicine has changed termendously. It still doesn't take into account the substitute for the residents and how much worse they would cost. (Yes residents might lower productivity of attendings per patient, but now attendings can handle more patients).

-------------------------
One of the articles was published a year ago, another in 2001. I am not a fan of articles more than 5 years old, but like the other poster, I haven't found anything recent. There is nothing to suggest that the changes in healthcare now have led to residents being cash cows for hospitals, in fact, quite the opposite has occurred - try to do some research. This is a very complex subject, because GROAN - medicare is involved. This makes things sticky - more medicare patients come into play because of the medicare funding for residents...it's all very circular and confusing.

 

[Hernandez]

Well, not to be continually snarky, but I hope most MDs did not go into it for the money. Far too much responsibility and hassle, not to mention education.

Then where is the incentive to take all the time and hard work to complete the education?

The market is what it is.
'''...like it or not, the market is paying those people because they are needed and there is a low supply...end of story.

This isn't exactly a free market now is it?

Anyway, stop attacking my posts. I said residents should make more even though I have nothing to personally gain from such an income increase. I just think they are veritable slaves for hospitals and that's wrong and very anti-free market.

I'm nit-picking you because you're being duplicitous with your posts. On one hand you say it's anti-free market, but just before this you justified the pay as being what the market is.

The average Doctor easily bills over $1 million dollars a year for services, yet the average is $150k? I'm sorry, but exactly how does that sound like market value? And why do doctors get paid less per visit to manage someone's health than a plumber can make unclogging my sink? The market is screwy, and it has nothing to do with free-market forces. It hasn't been a free market since the advent of Medicaid.

Oh and one other thing - nurses do a lot more than "take orders." In fact, that very phrase brings to mind an antiquated way of looking at medicine. When you're out in the trenches long enough, you might finally realize nurses and therapists have their own practice. Nurses look at orders as patient orders, not orders to be carried out as commanded by an MD. When I was a nurse, I would not carry out an order unless I felt comfortable with it - so I'd ask more questions or page the attending. Perhaps this made residents hate me, but in reality, they should be glad I was such a conscientious nurse and trying my best to do right by the patient. If this made me seem "difficult" to work with in the eyes of a resident, then that resident needed more perspective. Anyway, enough about that. Besides, I got along with residents anyway - Harvard residents are awesome - hardly any superiority complexes compared to lesser ranked hospitals. They are down to earth, they know they have nothing to prove. I love the community Mass. General had in its staff.

If it only every nurse were like you and just double checked before they decided what was best for the pt and ignored the orders they didn't feel like doing. but this hasn't been the status quo where i've worked. Now granted, I've not worked in a Magnet hospital either. I have several horror stories where the actions of not paging me and doing what they pleased damn well killed a pt, and i'm not someone who gets bitchy when you page me for any little thing. As long as it's my pt, and hasn't been addressed already, I'll answer you questions within reason.

The problem with any internet forum is you see the complaints and how those complaint tend to be over generalized and not directed at "oh bad nurses suck, and I wish they'd realize what a good reason to page me for is" But I've said it before, a good nurse is worth their weight in gold, unfortunately, I've not meet too many of those type.

 

[Hernandez]

One of the articles was published a year ago, another in 2001. I am not a fan of articles more than 5 years old, but like the other poster, I haven't found anything recent. There is nothing to suggest that the changes in healthcare now have led to residents being cash cows for hospitals, in fact, quite the opposite has occurred - try to do some research. This is a very complex subject, because GROAN - medicare is involved. This makes things sticky - more medicare patients come into play because of the medicare funding for residents...it's all very circular and confusing.

You're going to have to start posting sources, I've spent some time on OVID and can not find any articles which related to residents costing hospitals money.

 

[Hernandez]

If you are looking for analysis here is some. This particular study shows a net loss per resident:
http://www.stfm.org/fmhub/fm2006/June/Judith408.pdf

This study says nothing about the hospital taking a loss for residents, it only shows the institutional cost accrued per resident.

Here is a study from 95. At that time programs made a little money from FM and took huge losses from surgery:
http://gateway.nlm.nih.gov/MeetingAbstracts/102215440.html

Again, Costs/resident does not equate to "loss" And the implications make no sense if you look at it in the context of a "loss" "These results provide some indirect support for reduced reimbursement for medical education if more primary care physicians are trained" Why would they decrease reimbursement if the programs were taking looses for training?

I can't find the full abstract at the moment, but I'll find it in a day of two to further pull it apart.

Also note that resident costs decrease as the program is larger as evidenced here:
http://archinte.ama-assn.org/cgi/content/abstract/161/5/760

David Carpenter, PA-C

And where does it say that there is any monetary "loss"? I've only speed read it, but my first reactions are, no where does it say loss, it ignores other financial savings the residency program saves the hospital it is associated with, and (again) it does not say there is any monetary loss per resident. And this sentence jumped out at me "This confirms what was noted in the original data: that programs with lower cost per resident achieved that primarily by controlling expenses rather than enhancing revenues." And I believe the point of this study was that without either further funding, or without an increase in revenue, or a decrease in associated expenses, residencies will become fiscally impossible to maintain.

There was also this blurb in this article "A 2004 study of the public policy value of state funding of family medicine programs through resident stipends
in Oklahoma estimated a return of $370 million on an "investment" of $139 million." NIH's website is down, so I can not pull up this article to evaluate and critique it either. I'll get to it later.

 

[notherenorthere]

I am sort of thinking we're spinning wheels here. However, I do want to clarify something. I talk about the market - of course the health care market is not truly "free." That is what makes it so confusing for people. However, in the case of nurses, it really is a supply/demand issue - coupled with evidence based medicine (the hot thing in healthcare finance) that a better nurseatient ratio equals lower costs...

there is nothing about this that is at odds with the fact that I said residents' pay structure is anti-free market. It IS, if you consider a resident a market good (in a way) and the residency programs are essentially "price fixing" the salaries of residents and if this was not happening, they would be worth far more. It's an antitrust issue - people have tried to bring suit on it but there is some loophole that allows this sort of thing. In all honesty, I took an antitrust class but we never read a case on resident physician issues, so I am not sure what the loophole is - but there must be one, because the whole resident structure from match day through training is anticompetitive. So if residents really do earn huge revenue for the hospital, they should be getting paid more if it were a competitive market, which it isn't.

At any rate, I don't have time to do more research on this stuff...maybe someone else will. Maybe I'll ask some health policy experts I know about it. They'll have something to say for sure.

As for the nurses thing, I am sorry you have had not such great nurses to deal with. There are a lot of problems in the nursing profession. I also suspect you do not have a lot of experience - you're an incoming intern, or intern now?? I don't know. Anyway, as a nurse, I generally went under what the patient orders were, but since I was in ICU, I had a lot of autonomy. That doesn't I chose which antibiotic to order LOL, but I would start/stop/titrate pressors to my choosing, give some fluid if someone's symptoms warranted it...replete lytes, draw labs if I felt like doing it, make vent changes....basically tool around the patients rooms all night fixing them up....then the junior would wake up around 5 and be VERY happy that I was so aggressive, 'cause they would put all the orders in and get credit on rounds....hey I don't care. I did all the work, they stuck orders in after the fact, but my pleasure came from positive outcomes, not getting credit !!!!
PS - None of my aggressive nursing care like this as residents slept ever resulted in bad outcomes - it was normal practice in my ICU and there are probably still an amazing group of nurses in that ICU who do the same stuff.

 

[notherenorthere]

One of the abstracts (can't remember which) clearly states that surgeons cause losses, psychiatry generates profits, and medicine generates slight profts.

The family medicine article is pretty clear in demonstrating how costly the programs are.

the last article is unclear so I agree I do not know if cost equates with loss. It could, it might not. I don't know.

 

[elwademd]

trying to get back to what the op was discussing:

A San Francisco Board of Supervisors committee approved labor contracts Monday that boost police and nurse pay -- raises officials say are needed so the city can compete with nearby counties and private employers offering richer employment packages.


If the new pact receives final approval, an entry-level San Francisco police officer's salary will go from $65,500 to $70,733, and a top-level officer's salary will jump from $91,182 to $94,829 in the first year

Under the proposed contract, pay for entry-level registered nurses would increase from $98,410 to $100,255 in the first year of the pact.

entry level registered nurses (rn's)... not seasoned vets. i.e., 1st year of completion of an rn program. rn's now have residency programs (such as versant, which is at my hospital). it would seem to me that a nurse first year out versus an rn with 4 or 5 years experience would be similar to an intern versus an md with 4 or 5 years experience...

what would make sense to me, would be to end a salary, and give us a decent per hour rate, and let us clock in and out like everyone else:

80 hours per week x 49 weeks (subtacting 3 out for vacation) is 3920 hours
pay is 40-50k per year
i.e. 10.20 (40k/year) to 12.76 (50k/year) per hour.

pay residents 15 bucks an hour and it'd put the gross income at 58800 (at 80 hours/week, with 3 weeks vacation).

20 bucks an hour, and it'd put the gross income at 78400/year (again, at 80 hours/week, with 3 weeks vacation).

with a decent hourly rate, programs and the public might figure out what we're worth, or they'd figure out how to cut down our workhours so as not to pay out so much.

is being a physician a noble service? sure
did we go into residency knowing the drawbacks? sure

but that doesn't negate the fact that when one looks at what we make per hour, we could make just as much money as a cashier at a grocery store without all of the responsibility, liablity, hassle, headaches, etc. etc.

with that said, we as residents (and i suppose those that care what happens to residents) have a long uphill battle if resident salaries are going to be changed. the "powers that be" don't want the current structure of residency and it's pay scale (or lack thereof) to change. of course, they'd rather not have the hours change as well (which is another topic for another thread).

and then comes the other battle as attendings with medicare/medicaid etc. for billing and reimbursement to be changed...

 

[core0]

This study says nothing about the hospital taking a loss for residents, it only shows the institutional cost accrued per resident.

Total Program Expenses and Cost Per Resident, Including Uncontrolled Data*
# of Programs Median Value Mean Value Range SD
2003 total revenue/resident FTE 12 $257,644 $246,688 $178,700–$319,106 $49,170
2003 total expense/resident 12 $250,613 $285,352 $190,539–$429,674 $85,810
2003 total cost/resident 12 $33,276 $38,664 -$22,413–$232,948 $94,633

Unfortunately with SDN I can't get the table to work. But the mean cost (income - expense was $38k so yes it does show a loss on the residents (table 4a page 413).


Again, Costs/resident does not equate to "loss" And the implications make no sense if you look at it in the context of a "loss" "These results provide some indirect support for reduced reimbursement for medical education if more primary care physicians are trained" Why would they decrease reimbursement if the programs were taking looses for training?

"Evaluated at the means of teaching facilities, the marginal cost of a surgical resident is $252,361, of a psychiatric resident is $138,811, and of a medical resident is $90,525. The production function analysis finds a similar pattern, with residents in psychiatry generating more output than their wage, those in medicine having a small positive effect, and those in surgery generating negative outputs. Further, surgical residents reduce the productivity of staff physicians."

I would agree that this doesn't show loss, but if the marginal cost (and I am not sure if they are using it correctly here) is $252k for a surgery residency resident then even using 2003 data there is no way to make a "profit". If they are using marginal cost correctly every "unit" of surgery resident costs $252k more to produce (this would not fit supply and demand curves but we have already acknowledged that residency is purposely outside of supply and demand). This may be that the reduction of surgical efficiency is magnified as the residency program gets bigger.

While this is old data, what the article attempted to show was that hospitals (under a 1995 model) would make more money by producing more primary care physicians (which was all the rage in the 90's). As far as decreasing reimbursement, there is no corollary between reimbursement and costs for training. Costs have gone up significantly (look at costs in the FM paper above) while reimbursements have not. At some point in time it becomes cheaper (especially for community hospitals) to get rid of the residency.

I can't find the full abstract at the moment, but I'll find it in a day of two to further pull it apart.




And where does it say that there is any monetary "loss"? I've only speed read it, but my first reactions are, no where does it say loss, it ignores other financial savings the residency program saves the hospital it is associated with, and (again) it does not say there is any monetary loss per resident. And this sentence jumped out at me "This confirms what was noted in the original data: that programs with lower cost per resident achieved that primarily by controlling expenses rather than enhancing revenues." And I believe the point of this study was that without either further funding, or without an increase in revenue, or a decrease in associated expenses, residencies will become fiscally impossible to maintain.

Yes but how do you control expenses - salaries for support staff for the residency and for attending. Not exactly the way you want to go. As far as loss, the amount of income for a program is relatively fixed and the expense is higher for a smaller program so this generates a loss. This paper would seem to confirm this (at least for family practice).
http://www.stfm.org/fmhub/fm2003/November/Gonzalez.pdf

Note that most of the programs are community based lending credence to the point that presumably smaller programs don't have the infrastructure to carry the expense of a residency. It may end up that community based residencies are not a viable model under current reimbursement guidelines.


There was also this blurb in this article "A 2004 study of the public policy value of state funding of family medicine programs through resident stipends
in Oklahoma estimated a return of $370 million on an “investment” of $139 million." NIH's website is down, so I can not pull up this article to evaluate and critique it either. I'll get to it later.

This is a good argument for residencies since it looks at downstream revenue from physicians for the state. But unless the state is willing to pony up some money it doesn't help the hospitals.

Bottom line, it is unlikely that residency programs are cash cows swimming in extra money (at least based on the published data). They probably operate at a small net loss for the most part. If you can successfully cut the expenses you can probably make some money on a residency program. Expenses primarily consist of support staff and attendings.

Bottom line if you want to change residency salary in a meaningful way the billing and compensation system has to change.


David Carpenter, PA-C

 

[Faebinder]

trying to get back to what the op was discussing:

entry level registered nurses (rn's)... not seasoned vets. i.e., 1st year of completion of an rn program. rn's now have residency programs (such as versant, which is at my hospital). it would seem to me that a nurse first year out versus an rn with 4 or 5 years experience would be similar to an intern versus an md with 4 or 5 years experience...

what would make sense to me, would be to end a salary, and give us a decent per hour rate, and let us clock in and out like everyone else:

80 hours per week x 49 weeks (subtacting 3 out for vacation) is 3920 hours
pay is 40-50k per year
i.e. 10.20 (40k/year) to 12.76 (50k/year) per hour.

pay residents 15 bucks an hour and it'd put the gross income at 58800 (at 80 hours/week, with 3 weeks vacation).

20 bucks an hour, and it'd put the gross income at 78400/year (again, at 80 hours/week, with 3 weeks vacation).

with a decent hourly rate, programs and the public might figure out what we're worth, or they'd figure out how to cut down our workhours so as not to pay out so much.

is being a physician a noble service? sure
did we go into residency knowing the drawbacks? sure

but that doesn't negate the fact that when one looks at what we make per hour, we could make just as much money as a cashier at a grocery store without all of the responsibility, liablity, hassle, headaches, etc. etc.

with that said, we as residents (and i suppose those that care what happens to residents) have a long uphill battle if resident salaries are going to be changed. the "powers that be" don't want the current structure of residency and it's pay scale (or lack thereof) to change. of course, they'd rather not have the hours change as well (which is another topic for another thread).

and then comes the other battle as attendings with medicare/medicaid etc. for billing and reimbursement to be changed...

Unfortunately, supply and demand says you cant win this battle yet and the higher ups are incharge of that fact. Why? The supply is plentiful. With so many active applicants not matching, programs will happily replace troublesome residents in a heartbeat. Sure it might make them look bad... for a few months, till the next round about of new graduates come knocking at their doors to be let in as residents. To fix such a problem you need to either a) Increase number of residency positions or b) Decrease number of incoming active applicants.

It's kinda funny, residency is like being in a master program or phd program but a lot more intense and you dont have the option to leave. You're only temporary in the program, not that many people out there are like you (# of residents is less than # of attendings and less than # of students), and by the time you have been around the block enough to start complaining about it you move on and you are all done and the problem gets left behind in someone else's lap. Worse, unlike the students, you don't truly have an institution/university to defend you despite the claim that you are in a higher "education" training program.

I like the union idea for residents. I would love to see more studies done on the cost/value of residency to institutions. I would love to see a metaanalysis performed for sure but for that we would need multiple decent studies.

 

[Faebinder]

This is a good argument for residencies since it looks at downstream revenue from physicians for the state. But unless the state is willing to pony up some money it doesn't help the hospitals.

Bottom line, it is unlikely that residency programs are cash cows swimming in extra money (at least based on the published data). They probably operate at a small net loss for the most part. If you can successfully cut the expenses you can probably make some money on a residency program. Expenses primarily consist of support staff and attendings.

Bottom line if you want to change residency salary in a meaningful way the billing and compensation system has to change.


David Carpenter, PA-C

First, that cost analysis is inadequate, it once again accounts for direct revenue + cost + expense but does not account for what would it cost to have the resident replaced. A mid-level doing 60 hours a week would approximately cost $120k a year. I don't see that in any of the calculations and it is a valid substitution.

Second, I started to realize why studies like to show the loss and avoid talking about how much net money is made by the institution from residencies. If the studies do start to show that residencies are net profitable, the medicare reimburisement will start to argue that it wants to decrease GME funding cause residents are profitable as they are and they need to use that money elsewhere. You just can't win with medicare, it wants to cut down whether residents are good for the institution or bad (cost too much, lets keep their numbers down, they make more than enough for the institution, lets not give them as much.)

 

[gutonc]

Do any residencies match any 401k/403b savings? I doubt it.

Ours does starting last year (my first year), through GME so its all of the residents. And although it is - legally at least - a 403b, the university actually contributes to it regardless of whether or not you put any money into it. They have a base contribution and then will match resident contributions to whatever amount the law allows per year.

 

[burke99]

The only way to stop this from getting worse and to help things improve is by banding together and demanding / showing people that we deserve to get paid more after all that we go through. I've mentioned this before and I'll mention it again, I have friends who out of their first year of college were making close to $100k. And now at the age of 25-26, a good majority of my friends are up at that level. Needless to say that by the time they are of the age people would generally finish a residency they'd be making much more.

They never had to 'take call'. Never had to apply for a 2nd degree. Never had to pay for another $100k to $200k in schooling. Don't have to pay for malpractice insurance etc. The list really goes on and on, but somehow doctors in general are either too proud or too caring to say that there is definitely something wrong with the way we're compensated (including residency).

A good majority of doctors also think that we are the ones who should change by lowering our expectations or moving to cheaper suburban areas etc. And the rest of us don't have the time or don't know where we could even go to start making progressive strides towards a situation like this with out coming off as money grubbing & shallow despite the fact that we've essentially dedicated ourselves to a lifetime of helping people.

I agree with your logic. I am becoming a physician because I genuinely love the profession. However, when you factor in 200,000 to 300,000 of debt just to become a doctor. Is a starting salary of 120,000-175,000 for a PCP enough to pay back those loans, purchase a house, buy the engagement ring for your girlfriend or even start a family. You become so far behind and all these doctors just accept all the paycuts and getting beat on by insurance. Doctors are not greedy, they put in a lot of time and effort and debt, while police in suffolk county long island make over 100k after five years without any debt, without pushing their lives back seven plus years, etc. etc. Physicians need to unionize or something because it is getting ridiculous. Hopefully, we can make some changes for the better!