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Never mind, not worth it. based on other threads, it appears you are just looking for some sort of debate/s. Good luck
No? Based on what other threads?Never mind, not worth it. based on other threads, it appears you are just looking for some sort of debate/s. Good luck
If you want to read it that way, fine, but I think most people are simply saying that $10-14/hour for a resident's labor is a pittance, and the average citizen would agree. I don't know why you think I'm saying my life decisions should change my residency obligations, because I never said as much.Your time in college is your choice and not the issue for the residency, nor is your choices of research, or future fellowship. My primary education emcompassed 18 years, and what? should I have felt undergrad should pay me? Maybe, adding med-school to that, it encompasses 21/22 years, should med-school pay me, enable me to have a family??? Depending on the choices you make, you can be working as an attending by age 35 or less. You can then work until 70 if you like.If you want to read it that way fine. My point isn't even talking directly about decreasing training hours, call, etc... It is talking about the issues of increased income and the commentary that suggests an individuals family making decisions should be in some way the obligation of the residency. There are numerous residencies around the country. An individual should shop wisely. But, your career/specialty choice and family choices are really yours and yours alone.
TheProwler, wasn't directed at you, rather the post before my comment. I initially posted a reply and then decided to delete its contents. Based on the individual's need to just argue and insisting on distracting another thread looking for definitions of extortion, etc....Never mind, not worth it. based on other threads, it appears you are just looking for some sort of debate/s. Good luckNo? Based on what other threads?...
I will leave to everyone to choose and look at the sum total of points made on this topic and not just to you specifically. I have not said YOU should have different obligations towards your residency because of your life decisions. Though, I have known plenty that wanted that as well. Thus my examples of individuals complaining about getting priority for certain holidays and such....The "salary" of a resident is supposed to technically be a stipend. A resident never was intended to be viewed as a longterm "career employee". The original intent was to provide adequate income to allow payment of basic living supplies to support the individual trainee during training. ...It is a slipperry slope and soon we will hear more and more about how much family support undergrads should receive!
The original intent was stupid then. Why should I have to eke out a few shekels for "basic living supplies" after spending nearly a decade in post-secondary education?...putting children off until you're an attending is asking too much for many people. If you're willing to wait, that's great, but it shouldn't be obligatory. My program does pay enough for all of us who are married to have children, and I think that's how all places should do it....I don't know why you think I'm saying my life decisions should change my residency obligations, because I never said as much.
...a little rhetorical... You write, "My program does pay enough for all of us who are married to have children, and I think that's how all places should do it...". Ok, so then who decides what "enough" is? Should it be "enough" for just a spouse? a spouse and a kid? maybe a spouse and a kid a year? a spouse, kid/s, in an apartment? maybe home ownership? Or is it up to the individual residents? i.e. you decide you want to own over rent and the program should provide more to enable you to do so? you decide to own, should there be alotted time off for home shopping, mortgage counseling, banking, etc...? Should there be a graduated pay system so residents that are single have "enough" with less then is given to those making a family? We should "means test" residents to determine their incomes...
And, I follow what you are saying. However, the issue still remains that you are getting a stipend to help cover your living expenses during TRAINING. I understand everybody wants to keep pushing these comparatives between residents and mid-levels. You may have a broader based knowledge then a mid-level. In the end, you are not a midlevel and you are still in training....I don't think it's about residencies providing a wage that allows for a person to raise a family, if that was the case a lot of jobs wouldn't pay enough. To me it's the simply question of whether the wage is congruent with the work being done. I just don't believe that 10-14 dollars an hours is a fair wage for someone who has gone through 8 years of training prior to residency and who is providing care and taking the responsibility for patients at a level that is more advanced than a RN, NP, PA...
It is not just about board cert. It is about being FULLY trained and FULLY competent. You are definately NOT fully trained until you complete residency. You may not even be fully competent in your specialty once you complete residency. It may take some years of practice after graduating to achieve full competency. But, you should be "safe" when you complete residency....It's easy to say well you signed up for it, you knew what you were going to get paid but this isn't a fair arguement. If you go through medical school, you are obligated to finish a residency if you want to be board certified so it's not truly an option.
It gets a little convoluted from what the legal status is... But, recent decision to reimburse ~tax withholdings I think were based on residents being trainees under federal funding. Also, most residents work under a trainee license with presumed inherant supervision. Finally, if it is correct that termination from a training program does not enable collection of unemployment..... I just don't know.Legally speaking, I don't think residency salaries are considered stipends as residents have been determined to be employees rather than simply students...
IMHO, this is a grass is greener distration and looses track of the main purpose you are there. Yes, "broad sense", but I don't need nor do I want to pay bigger dollars for a "broad sense". I want a mid-level that is fast, efficient, follows my instructions, and I can depend on them to be there month after month for those tasks. That is not a resident. A resident is being trained/groomed to be the leader not the to be minutia. I can do many things any member of the team can do. But, their tasks are not my strength they are their strengths.....I don't think that the comparisons are done to say I'm better than a midlevel. The truth is residents realize they are not at the clincal competency of an attending but look at other clinicians and realize that they are as competent or more competent (in a broad sense) as midlevels and question the compensation differences...
Not my experience with mid-levels. They are supervised when fresh grads and watched as they repeat the same few tasks over and over again. Every institution I have been at has a probationary period for mid-levels and their credentials are applied for with a supervising physician attesting to their competency. Also, they are required to show numbers of procedures, etc... So, no, I do not see it as a concern as their competency is validated/vouched for through a physician assuming the responsibility for task specific training and liability. The physician has a vested interest, putting their license on the line, to not over extend their mid-levels....There is an expectation of competency for MD/DO which is achieved through residency and years of practice. However, we let mid-levels perform some of the clinical tasks residents due without a true measure of competency (no residencies, limited post-graduate training) and compensate them well without true validation. Dont you see that as a concern? ...
Each state has its own licensing quirks. Being fulling licensed/unrestricted does not equate full competency. The fact is compensation is now being paid differently based on complete or did not complete residency? board certified or not board certified? So, full license means you have enough broad based knowledge that the state trusts you will behave safe. It does not indicate general competency in any particular tasks nor does it indicate entitlement to hire compensation. My mid-levels are competent in what they do and do over and over again. They have since surpassed me in their ability to do some tasks faster and more meticulous then I because they have surpassed me in shear volume of experience doing it. So, my answer to that question, no....Further, some states allow for residents after an internship to be given a full medical license, without being BE/BC. If a state is saying that you are competent to hang up a shingle and practice medicine independenly shouldnt that be recognized in compensation to residents?
It gets a little convoluted from what the legal status is... But, recent decision to reimburse ~tax withholdings I think were based on residents being trainees under federal funding.
But, based on there proposed and fought rule changes, maybe they do and thus their multiple legal losses.IRS said:http://www.irs.gov/newsroom/article/0,,id=219731,00.html
...The Internal Revenue Service has made an administrative determination to accept the position that medical residents are excepted from FICA taxes based on the student exception for tax periods ending before April 1, 2005, when new IRS regulations went into effect...
It is not so much what the IRS considers as much as what the courts/law considers. The IRS needs to split the decisions to get to the supremes.... for now, the IRS considers residents employees. for all legal purposes, unless the SCoTUS changes dicta, we are employees with none of the protections of employees,
I am not sure the IRS still holds the position as you describe:
But, based on there proposed and fought rule changes, maybe they do and thus their multiple legal losses.It is not so much what the IRS considers as much as what the courts/law considers. The IRS needs to split the decisions to get to the supremes.
http://findarticles.com/p/articles/mi_m3257/is_1_63/ai_n31297914/
In the end, you are NOT competing with the mid-level. Hopefully, you will never be an excellent mid-level. This need to point at everyone around you and start making comparisons and feeling under-valued as compared to the person next to you in another field is insane. Great, I think I should be compensated more then a pro-athlete. The school teachers believe they are more important cause, "the children are the future...". Plenty of specialties think they contribute more then they are compensated in comparison to others. By all means, get into residency, get all caught up thinking you are more valuable then this person or that person and being treated unfairly. Good luck. I have been at residencies that toyed with the idea of some compensation differential. Of course, based on hours and number of patients, surgery was going to be paid more then ER and IM. Both had caps in patients and hours (hours below surgery)....That's what I see more value in what the resident does and believe that their compensation should be in line with or exceed the midlevel despite the "training" tag.
Which is ~true. As pointed out through out this thread, plenty of private practice and community hospital physicians that run their services without the almighty 14Kt lined residents....In the end, resident salaries are where they are because of economics and supply/demand. Residents must complete residency programs to be licensed / trained, hence salaries will reflect this. As mentioned, if I paid based upon true utility, PGY-1's might pay me for the first several months of training, and certainly for each elective month which doesn't help me at all.
In other words, you sugest a comparison in compensation between residents and mid-levels, then discuss pay cuts to mid-levels for pay increases to residents based on educational/responsibility/job description.... I think I/we got this numerous replies previous. Again, it is in fact a comparison between fields. How you figure this comparison and then subtraction in income from one group to add to another is not a competition; I do not know....I am not saying we as residents are competing with mid-levels. I compared residents to mid-levels because both are clinicians to some degree or another below the level of an attending. I don't think it's as much a stretch as you are making it to compare 2 different sets of clinicians based on training, hours, and level of responsibility delegated in order to determine a differential in compensation. I am also acutely aware that in medicine we are all fighting for a bigger piece of the same pie and that if one group (i.e. residents) grabs a bigger piece it could affect another group (i.e attendings). I would argue that instead of taking from attendings as you suggest, there might be a middle ground with non-attending staff (i.e PA/NP's) who based on my previous posts make significantly more than residents for less education, hours, and responsibility...
Your program would have fired you for saying you didn't think you were paid enough? Wow.Which is ~true. As pointed out through out this thread, plenty of private practice and community hospital physicians that run their services without the almighty 14Kt lined residents.
Everyone can grumble amongst themselves about how much more value they add and how unfairly paid they are. Or, you can loose your illusion by marching into your PD's office. Go, tell him/her how unfair the pay structure is, point at all the mid-levels and explain how you are worth more then them.... I am certain, as you pack your belongings and head home, out of a residency training, you will still be grumbling about fair and how much you are worth!
There in is the classic closing line.... Now, as I am not supporting your theories and agenda (arguably having more experience and training in these matters), I am thus ~traitor or on the ~enemy side. This is a discussion, however, about your comparative of RESIDENTS to the mid-levels. Very sublime....As someone who has gone through the training process it seems you are more pro mid-level than pro physician.
There in is the classic closing line.... Now, as I am not supporting your theories and agenda (arguably having more experience and training in these matters), I am thus ~traitor or on the ~enemy side. This is a discussion, however, about your comparative of RESIDENTS to the mid-levels. Very sublime.
The silly and unsophisticated marginalization argument aside, I wonder... How many PAs exactly are in any residency division. Are we talking 1 PA for 5 residents? In surgery, is that 5-7 PAs for all 25 +/- residents in the program? So, if they are earning $80k/yr. With, a good portion of it being billable revenue generation, how much does one purpose cutting their incomes? Will they stay or go into private practice to avoid pay cuts? If their cuts do not meet you salary increase needs, do you cut nursing? pharmacy? The janitorial staff? Maybe, as we watch an exodus of mid-levels to greener pastures, we should have government intervention and mandate all mid-levels complete a service tour at a teaching hospital....
Yes, it is competition no matter how many seperate paragraphs you split it. To say ~I am worth more then they [insert multiple paragraphs] thus they should have income taken and given to me... or their income should be cut to fund my income increase. At its core, your argument hinges on the belief that residents are better then mid-levels, residents are worth more then mid-levels, residents should be paid more and mid-levels be paid less.
The reality is that once a resident graduates from residency, they will seek a job. Based on current trends/markets, the grad will be ~overpaid for 1-3 years. That is, they will be given a clinical base pay guarantee higher then what they are billing/collecting. The strategy is to float them while they build a practice and market share/value. It is the same with mid-levels. Though, it is on lesser sums of money.
The mid-level will start at a teaching institution at $45-85k? They will work within one service, doing the same thing over and over, day to day, month to month. They may not be worth the base salary initially. However, with that consistency and dependability they will be worth it in about 12 months (unless the service is really low volume to begin with).
A resident is NOT training to be a mid-level. I do not want a resident on my service to be a mid-level. I want a resident to be on my service to learn what the need at this step of their training to move to the next step and ultimately to something more when they are fully trained. i definately do not want any resident that is staring at mid-levels and thinking the grass is greener and spending anytime debating with me how much more they are worth then the mid-levels. I have been there and I know what a resident is capable of and what they are worth. They are a future investment and I am not going to start paying-out and paying short today, prodigal son and all....
Yes, and so your asertion/implication remains, i.e. since I do not support YOUR position or YOUR argument, I am in some way not showing sufficient support for residents or fellows in general. You are wrong....As someone who has gone through the training process it seems you are more pro mid-level than pro physician....So yea, do I expect someone who has gone through residency to have a little more support for their fellow residents, absolutely...
Unfortunately, it is generally unbillable "work" and thus costs for insurance and benefits without actual reimbursement... see below.
everyone can get into a little peepy match on "salary" and use the "fair" word if you like. The issue is/are:
1. The residents' "work" that everyone believes is underpaid and should be by some peoples' opinions in the $80k range is suppose to be primarily educational, aka student learning.
2. Where a physician can bill for work done, a resident does NOT bring in any billable production. In fact, it is illegal outside of moonlighting... at a completely different institution then the sponsoring residency institution.
3. The federal government pays the hospital a set amount of money to the GME to cover resident costs. yes, residents are an expense. Many here apparently will argue they are more positive revenue then negative revenue.... However, see number 2 above. Also, the hospital must pay for your malpractice premiums, healthcare benefits, often dental, optical, disability, life, etc.... It also goes to help subsidize the lower volumes the physicians in theory perform at academic institutions in order to teach, etc....
4. So, I suspect many would want to know how much the federal gov pays per resident, and in general this can be 80-150K/yr. The issue is the number of ACGME approved residency spots at a given institution does NOT in most cases equal the number of federally funded spots. Most institutions have far more residents then funded spots.
5. Most undergrads and grads students are apparently able to fund themselves on financial aid and summer jobs... but are paying for their education. It seems as if plenty of people go from the negative income of medical school to the positive income of residency and suddenly need daycare money, vacation, etc....
Long and short, there are costs associated with TRAINING and thus with you being a TRAINEE. You can not work independently as a physician until you complete all USMLE and get an unrestricted license. But, you work under the protection and "supervision" of the training hospital. You can not really compare to a PA or NP. Once you have an MD you can't be hired in a lesser role... because you are now a physician which carries licensure requirements and malpractice coverage, etc.... For example, if a patient dies at a local nursing home where you are working part time as a janitor... you can't say, "it doesn't count cause I was not working as a doctor I was acting as a janitor...".
So, to all you undergrads, med-students, interns, ec.... Understand what residency pays, budget and do NOT get the misinterpretation that you should be paid "x" cause your a doctor and want to start a family, etc... during residency. You need to plan and budget. If you planned and budgeted well during undergrad and med-school, then you should find yourself a little better off now that you are moving into a little more positive income.
PS: go ahead and use the word fair regularly during medical school and residency.... explain to everyone what is fair to you and how much you provide. Keep in mind, numerous community hospitals are in the "black" and have no residents.....
And, I follow what you are saying. However, the issue still remains that you are getting a stipend to help cover your living expenses during TRAINING. I understand everybody wants to keep pushing these comparatives between residents and mid-levels. You may have a broader based knowledge then a mid-level. In the end, you are not a midlevel and you are still in training.
Most mid-levels I work with have a high volume of precise experience that makes them worth their money. I will not expect nor have I seen a resident with that specific focused level of expertice. A mid-level that just does one lmited group of tasks over and over again, twelve months out of the year will be better at that task then a resident transiently rotating on the service. I do not train residents to be more technically skilled then my PAs at the limted scope they work. It is just as I do not claim to be the difficult peripheral IV placer. The nurses, even the low experienced floor nurses have put in more IVs during a week then I have done through my entire general surgery residency.
So, accept that you are not a mid-level. Accept that this "better then" comparison is very flawed. Understand you are being trained to do more and assume greater responsibility.
Your "responsibility" falls UNDER the attendings' responsibility. Your work as a trainee is not billable in the vast set of circumstances. Also, as I alluded to earlier, once "billable" aspects get rolled into residency considerations, residents will become even less focused on the appropriate balance of training. This potential conflict can not be understated. Mid-levels do not enjoy the protections of residency. They do not enjoy any protected teaching time, post-call home, work hour limits, etc... That is because they are done and working within there trained career. You are there with a focus on training.
The very continued comparisons to midlevels and claims for need for ~billable equivalence, etc... is a very big distractor. Residents seem to be forgetting why they are in residency. That is, you are there to be trained. You are not there as a career employee. You are not there to prove superiority to a mid-level.
It is not just about board cert. It is about being FULLY trained and FULLY competent. You are definately NOT fully trained until you complete residency. You may not even be fully competent in your specialty once you complete residency. It may take some years of practice after graduating to achieve full competency. But, you should be "safe" when you complete residency.
You say that with such assurance. There is no good data to make that claim. The fact is mid-levels in numerous locations came second. They were hired to support the residents. In fact, when doing the surgery residency interview rounds over a decade ago, the sales pitch by the residents went something like, "the PD is really supportive of residents and education... it was bad before him/her. But, when they became PD they hired PAs & NPs and really made our lives easier...". Today, I still hear the residents use PAs & NPs as a sales pitch to interview candidates....False again. Residents are a net gain. Depends on specialty, but they definitely are a net gain for the hospital. Every resident means fewer attendings and midlevels around...
Your words not mine. I am certain taking things out of context may help you feel like you are winning some imagined point. However, that is not what I have said....Midlevels are better at patient care and technical abilities than residents?...
Yeh, sure, whatever you say. Again, the refuge of the pathetic....Now we see where the loyalties are hiding...
Where a physician can bill for work done, a resident does NOT bring in any billable production.
False. Absolutely and utterly false. RNs, however, do not bring in billable production, yet their value is high. What about nurse managers?
The federal government pays the hospital a set amount of money to the GME to cover resident costs. yes, residents are an expense.
False again. Residents are a net gain. Depends on specialty, but they definitely are a net gain for the hospital. Every resident means fewer attendings and midlevels around.
The issue is the number of ACGME approved residency spots at a given institution does NOT in most cases equal the number of federally funded spots. Most institutions have far more residents then funded spots.
False. Residents are funded, 1:1. There may be some exceptions, but it is very very very rare.
Wow.
Really?
Midlevels are better at patient care and technical abilities than residents?
Really?
Now we see where the loyalties are hiding...
I feel your pain. But someone has to pay the interest. If "no one" pays it, then the Bank does. Who do you think should pay the interest on your loans? The government? And if so, why?You know I would really just be satisfied if my loans would stop accruing interest while I was in residency. It's ridiculous that I have to take out all this money and then I'm expected to just sit there and watch the balance grow while I'm on a fixed income that was set well in advance of me even entering medical school.
You know I would really just be satisfied if my loans would stop accruing interest while I was in residency. It's ridiculous that I have to take out all this money and then I'm expected to just sit there and watch the balance grow while I'm on a fixed income that was set well in advance of me even entering medical school.
I feel your pain. But someone has to pay the interest. If "no one" pays it, then the Bank does. Who do you think should pay the interest on your loans? The government? And if so, why?
Everything in these statements speaks to individual personal decisions and what should be individual responsibilities. Nobody forced you to choose the education and ultimately career path you chose. Nobody forced you to take the loans. Nobody forces andyone to get married and/or have children. As you note, the general amount of expected income as a resident is well documented and should be well known by you long before you even enter medical school.You know I would really just be satisfied if my loans would stop accruing interest while I was in residency. It's ridiculous that I have to take out all this money and then I'm expected to just sit there and watch the balance grow while I'm on a fixed income that was set well in advance of me even entering medical school....A $2000-$3000/month payment for someone making 30-50k, some of whom have families, is f**cking ridiculous.
...Who do you think should pay the interest on your loans? The government? And if so, why?
Everything in these statements speaks to individual personal decisions and what should be individual responsibilities. Nobody forced you to choose the education and ultimately career path you chose. Nobody forced you to take the loans. Nobody forces andyone to get married and/or have children. As you note, the general amount of expected income as a resident is well documented and should be well known by you long before you even enter medical school.
Why should a MD/DO in residency have loan interest freeze? How about a law school grad that is working/clerking(whatever the term is) as a junior in a firm on minimal income until they can gain a full status, should their loan interest be frozen? How about PhD students, should their undergrad student loans interest be frozen while they do their research and years towards the degree? How about the nurse that wants to be a nurse practitioner, should their interest be frozen during NP school? DNP school? What makes a resident MD/DO special and deserving of an interest freeze? Is it that they, out of most other possible examples, are most likely to see the greatest financial return on their loans when done with training?
Ok, so eliminate the law school grad from the example. I don't think that equates to "most" of the examples. Change the law school grad to a law student, now everyone is a student.Because deferments on educational loans are granted to those who are still in school...
And of course most of your examples don't make sense because deferments are granted for people in school...
Again should they all have their student loan interest "frozen" or paid by the government......Why should a MD/DO in residency have loan interest freeze? [How about LAW SCHOOL students, should their undergrad student loans interest be frozen while they attend law school?] ...How about PhD students, should their undergrad student loans interest be frozen while they do their research and years towards the degree? How about the nurse that wants to be a nurse practitioner, should their interest be frozen during NP school? DNP school? What makes a resident MD/DO special and deserving of an interest freeze? Is it that they, out of most other possible examples, are most likely to see the greatest financial return on their loans when done with training?
Everything in these statements speaks to individual personal decisions and what should be individual responsibilities. Nobody forced you to choose the education and ultimately career path you chose. Nobody forced you to take the loans. Nobody forces andyone to get married and/or have children. As you note, the general amount of expected income as a resident is well documented and should be well known by you long before you even enter medical school.
As mentioned, they're no longer "trainees" (although it can be subjectively debated that they are still training...). Regardless, it is also known that lawyers who don't "make it big" soon after graduation[ also can run into fairly substantial financial problems especially if not well supported by the parents.Why should a MD/DO in residency have loan interest freeze? How about a law school grad that is working/clerking(whatever the term is) as a junior in a firm on minimal income until they can gain a full status, should their loan interest be frozen?
Conveniently forgot that med students also go through undergrad, thus physicians in training have an additional burden on top of what PhD students encounter. They receive a stipend similar to residents but do not have the burden of medical school debt which is in addition to and substantially greater than undergrad debt.How about PhD students, should their undergrad student loans interest be frozen while they do their research and years towards the degree?
Heh, yeah sure, if their training was so difficult so as to not be able to work while going to online DNP schoolHow about the nurse that wants to be a nurse practitioner, should their interest be frozen during NP school? DNP school?
Depending on what field of medicine one decides to go into, the "greater" financial return after training isn't really so substantially great. Big name lawyers can make equal or greater than big name docs. And, not wanting to open a new can of worms here, but it's well known that nurse anesthetists can earn more than a family med doc with far fewer years of training required. That much is fact. Hell, most DNPs make similar to what bread and butter family med and internal med docs make. Besides that, what makes us "unique" is simply the length of training plus inability to acquire other jobs in the process (besides moonlighting, which as some have pointed out is becoming more and more a thing of the past). Truth is, for some of my classmates who get no parental support whatsoever and aren't privy to scholarships, I really do worry about how they're going to manage their debt even after they reach attending.What makes a resident MD/DO special and deserving of an interest freeze? Is it that they, out of most other possible examples, are most likely to see the greatest financial return on their loans when done with training?
Have you been to med-school? Do you understand human reproduction? Woman can and do delay childbearing into their thirties; not just within the medical field either. As to women enterring medical school later in life, again, a personal decision. The individual makes different decisions, doesn't enter college straight out of HS or doesn't enter medical school strainght out of college, now her drive to reproduce is somehow the residency program's problem to accomodate, cause what she put off is now their emergency????...no other field of training can utterly consume a person's life clear into their thirties. ...but for women, especially those who do not enter medical school straight from undergrad, they simply cannot reasonably delay childbearing for that long...
There is no conveniently forgot anything. I am quite aware of the different scenarios. I just find all this ~grass is greener over there, I want to stay over here but give me their grass arguments very, very sad....Conveniently forgot that med students also go through undergrad, thus physicians in training have an additional burden on top of what PhD students encounter. They receive a stipend similar to residents but do not have the burden of medical school debt which is in addition to and substantially greater than undergrad debt...
Love that one, "compensation disparity". You can find that one discussed all night long in the FM forum. Or, you can go down to your local PTA meeting and hear that one, or the local fire house, or the college campus grad student associations.... let us not forget the out of work laid off folks, they talk about disparity in compensation all day long....I challenge you then, how do you bridge the gap in compensation disparity or do you not believe in increasing resident compensation at all?...
Have you been to med-school? Do you understand human reproduction? Woman can and do delay childbearing into their thirties; not just within the medical field either. As to women enterring medical school later in life, again, a personal decision. The individual makes different decisions, doesn't enter college straight out of HS or doesn't enter medical school strainght out of college, now her drive to reproduce is somehow the residency program's problem to accomodate, cause what she put off is now their emergency????
.There is no conveniently forgot anything. I am quite aware of the different scenarios. I just find all this ~grass is greener over there, I want to stay over here but give me their grass arguments very, very sad.Love that one, "compensation disparity". .
And, in that whole song and dance, the fact remains, everything is hinging on an individual adult making life choices and the implication is that somehow for some reason in some way a residency program should have responsibility for those choices. I am very, very happy to see women in healthcare. But, as you note, women know the costs, risks, etc... They make their choices and if the are infertile at age 18 or having a healthy child at age 40 so be it. Again, you are arguing some sort of social justice point of view. If we want to be "fair", why not say undergrad is funded for women to enable childbearing? I mean, looking at the charts and such, it may be unreasonable to expect a woman to put off pregnancy from age 18/19 and potentially have a drop of +/-25% in their chance of getting pregnant.... There's this thing called life ...women have increased difficulty conceiving the older they get. Some women are unlucky and have a hard time getting pregnant past a certain age. Nobody knows who those people will be or when that age is. ...So women are taking chances with fertility the longer they wait. It's not uncommon for undergrad degrees to take longer than 4 years, or for a person to work for a year or 2 before starting medical school. Tack on a 3-4 year residency and a 2-3 year fellowship and you can EASILY be in your mid-30s by the time they're attending. Add on another year or so to stabilize the career and another couple years if *gasp* a couple wants more than one child, and really, it's not unreasonable to argue that fertility is a limiting factor...
...There is no conveniently forgot anything. I am quite aware of the different scenarios. I just find all this ~grass is greener over there, I want to stay over here but give me their grass arguments very, very sad.
....Love that one, "compensation disparity". You can find that one discussed all night long in the FM forum. Or, you can go down to your local PTA meeting and hear that one, or the local fire house, or the college campus grad student associations.... let us not forget the out of work laid off folks, they talk about disparity in compensation all day long.
And, in that whole song and dance, the fact remains, everything is hinging on an individual adult making life choices and the implication is that somehow for some reason in some way a residency program should have responsibility for those choices. I am very, very happy to see women in healthcare. But, as you note, women know the costs, risks, etc... They make their choices and if the are infertile at age 18 or having a healthy child at age 40 so be it. Again, you are arguing some sort of social justice point of view. If we want to be "fair", why not say undergrad is funded for women to enable childbearing? I mean, looking at the charts and such, it may be unreasonable to expect a woman to put off pregnancy from age 18/19 and potentially have a drop of +/-25% in their chance of getting pregnant.
All the "god" and "all knowing" distractors are cute, albeit primitive. Since you have some difficulty in complete quoting and/or splicing of what I wrote, I repost below and individuals can look back to the links to see the actual statement to which I was responding:
Again, these are choices. One doesn't have to do additional fellowship if you do not want to. You can do pedes, IM, FM, any number of specialties on the shorter side if you CHOOSE. The tunnel only gets longer by the individual's choice. Other then failing to meet standards for promotion, I know of no residency that while one is in it they are told,~ oh, by the way, instead of 3 years we are going to extend the required residency to 4 or 5 years of training.... The vast majority of longer paths take a dedicated choice and quite a bit of work to achieve. It is sad for an adult to realize such realities late in the game....medical training continues to effectively lengthen due to the preponderance of fellowships and those of us in the midst of it are starting to realize...
Again, these are choices made by adults to pursue a specific career path. Nobody has forced anyone into this path or forced them to not get married or not have children. But, if you choose to have children, that is on you. It is not the residency program of 3, 5 or 7 years responsibility to make things up to you because you did or did not choose to put things on hold....it's actually not reasonable to force trainees to perpetually delay their goals, as medicine has and continues to do for increased periods of time and with dimmer and dimmer financial prospects...
Again, it is a career CHOICE. And, lengthening to super specialize is another choice and not an obligation or need. In fact, most medical groups are constantly citing the trainees desire/choice to pursue fellowship and super specialization as contributing to lack of available providers. The vast majority of individuals I know that do fellowships and/or super fellowships often cite as one of the primary reason, a desire to NOT do what they are trained to do. i.e. many do breast fellowship (yes they like it too) but largely because they do not want to do general surgery or general surgery call or trauma call, the same any multitude of other fellowships. It is often they like one thing and want that diploma to justify avoiding much of the "bread & butter". So, no there is not a "need" to super specialize. It is clearly a choice....training is ...career choice and continues to lengthen with increasing need to super specialize...
Costs at university and med-school may be rising but I do not see how medical school length or residency training length is increasing....Medical school costs are increasing. Length of training is increasing. These changes are significant and continue to increasingly burden trainees...
I always love the pre-meds' & med-students' perspective and judgement, especially when they haven't even gotten to a point of first hand experience to then make these comments and judgements. I especially loved the fellow med-students in med-school that actively investigated to see if they could get jobs as expert witnesses. Yep, I'm sure you know how bright these attendings are, yep, that's not arrogant at all.......Frankly I do get tired of arrogant know-it-all attendings many of which are actually not quite as bright as they imagine themselves to be...
Again, these are choices. One doesn't have to do additional fellowship if you do not want to. You can do pedes, IM, FM, any number of specialties on the shorter side if you CHOOSE. The tunnel only gets longer by the individual's choice. Other then failing to meet standards for promotion, I know of no residency that while one is in it they are told,~ oh, by the way, instead of 3 years we are going to extend the required residency to 4 or 5 years of training.... The vast majority of longer paths take a dedicated choice and quite a bit of work to achieve. It is sad for an adult to realize such realities late in the game.Again, these are choices made by adults to pursue a specific career path. Nobody has forced anyone into this path or forced them to not get married or not have children. But, if you choose to have children, that is on you. It is not the residency program of 3, 5 or 7 years responsibility to make things up to you because you did or did not choose to put things on hold.Again, it is a career CHOICE. And, lengthening to super specialize is another choice and not an obligation or need. In fact, most medical groups are constantly citing the trainees desire/choice to pursue fellowship and super specialization as contributing to lack of available providers. The vast majority of individuals I know that do fellowships and/or super fellowships often cite as one of the primary reason, a desire to NOT do what they are trained to do. i.e. many do breast fellowship (yes they like it too) but largely because they do not want to do general surgery or general surgery call or trauma call, the same any multitude of other fellowships. It is often they like one thing and want that diploma to justify avoiding much of the "bread & butter". So, no there is not a "need" to super specialize. It is clearly a choice.
What this discussion seems to boil down to is avoiding ownership for choices. There is a vast amount of ~I am forced to do or I needed to do as if someone held a gun to your head or held you hostage. That is just not reality. General surgery is and continues to be primarily a 5 year training program and does not require additional fellowship. FM is and continues to be a 3 year training program. I have not seen significant growth in length of training and in fact more and more "integrated progrms" are arising to specifically shorten training. Any added time or delay in gratification is your choice.Costs at university and med-school may be rising but I do not see how medical school length or residency training length is increasing.I always love the pre-meds' & med-students' perspective and judgement, especially when they haven't even gotten to a point of first hand experience to then make these comments and judgements. I especially loved the fellow med-students in med-school that actively investigated to see if they could get jobs as expert witnesses. Yep, I'm sure you know how bright these attendings are, yep, that's not arrogant at all....
I'm not following what you are talking about or if you are trying to reference something from another thread out of context...The irony that the old guard who argues that health care reform will drive non-procedural specialties into the ground being the same guys saying it's not "required" to specialize in order to stay afloat is not lost to me...
Beware the belief that you can estimate you specialty salary in the future... ortho was not always the big payer, anesthesia was predicted to be dying..... Are you going to be coming back tallking how unfair everything is because you chose a field with the belief you would earn/deserve 300K, 400k, or 500k?...Medical school tuition ...continue to rise year over year well above inflation rates. The financial pressure to go into a well paying specialty, if the drive was ever great before, is even greater now...
I think the cop-out is claim to be "forced" or some extrinsic "need" as opposed to accepting responsibility for your choices. I still recall living with family in a developing nation some decades ago. I recall living in a two bedroom, one bathroom (sic) home with five people, no clothing wash machines, no dishwasher, limited times of hot water. I remember knowing we were better off then many and were in a better neighborhood. So, yes, you can pursue a specialty that takes 5yrs, 7yrs, 10yrs, etc... Yes, you can pursue a hope for an income exceeding 300K, 400k, or 500k? But, these are choices and there are trade-offs....Saying everything is a choice is a very easy cop-out answer to any question for anything. Does anyone NEED to live in so gracious as a 600sqft studio, or god forbid a 2000sqft house?? No, humans can well live in 100sqft if need be. Do we NEED to be so extravagant with our every day meals or can we sustain on the bare minimum nutrients that many in 3rd world countries subsist on? Do we NEED to drive to work everyday or can we just ride bikes instead and get up 2 hours earlier to make the commute? Yeah, these are ALL choices are they not? Just about the best cop-out of all cop-outs..
What is apparent is your deficit in reading comprehension.... It is apparent from your previous posts that you barely acknowledge, if at all, that medical training is unique from other career options in length and cost. That alone strongly discredits your perspective on the current situation of trainees...
Nobody has a perfect crystal ball and that is not what I am or have stated. However, the duration of training is well and widely known and published. It should not take much for any mediocre level of intellect pre-med or med-student to do the simple math and understand how old they can reasonably expect to be at any point during their training path. Also, the amount of compensation during residency is no secret and is quite easily obtained.... tries to rationalize that choosing to become a physician means you should know going in what lies ahead. I would argue very few potential medical students can truly grasp what they are getting into. How could they? When you choose to go to medical school, you are simply choosing to undergo the process of becoming an MD/DO. It is not an acceptance of less than equitable wages compared to other health care staff.
I am all for further information. Again, that information is not difficult for a university level, bright go getter to research and make an informed decision. Crying how unfair it is or how one didn't know is sad. The best thing you or I can do is be honest and accurate and provide the information to enable informed choices early and not developed parachutes for all those too lazy to bother and look or ask....
Yes, your debate, discussion, and rational thinking ability are of the highest caliber. Thank you for keeping your adult wits about you....Thanks and you can continue to be a condescending douchebag as you have been throughout this thread. I'm sure your students just love you.
"Supposed to"... according to who? The variation is a matter of choice. You want to do multiple majors and minors, great do it, but understand the time it adds and understand if you have a dream/plan to be a physician you are choosing to add time....1. Undergrad can vary significantly from 2-5+ years. I finished undergrad in 2 years and know people who double majored with multiple minors who spent 5 or more years. How can a high school student who is supposed to go into their undergraduate studies with an open mind know what path they will end up taking?...
As you note, they "decide" (i.e. choose). Which is fine, take time off or double major if you like. That is your choice. The numbers are easy to calculate....2. Med school fairly straightforward length with the exception of those who decide to puruse a PhD or some who take time off in med school for degrees such as an MBA...
I think I outlined a very simple five point way in which anyone can gaugue the possibilities in my earlier post. You can very easily have a reasonable idea of the lengths of different pathways. And, if someone decides they want to go a long pathway, they should understand they may be giving up other opportunities to pursue this one. It would be nice to say everyone should have every opportunity at every stage and not have to worry about their decisions and the impact on the next stage. But, that is adolescent thinking and not adult thinking. Having an open mind does not require one to be ignorant. In enterring medical school, one should know a primary care track will reasonably take three years after med-school and general surgery can be expectedted to take five years, and any other combinations....3. How can an undergrad know what length of residency they will have. If you do what you are suppose to and entere med school with an open mind your training can range from 3-10 years. I went to a med school that pushed primary care (3 year residencies) and ended up deciding between rad onc and neurosurgery (5 and 7 years). No one knows the length until the actually go through the rotations and makes a decision...
Your right, reading and asking questions are not perfect and do not replace first hand experience. Even as a resident, you don't fully grasp the responsibilities faced by attendings or PDs. Still, that does not change the fact that you can look at published information and can speak with residents while you are in HS, undergrad, med-school. You can speak with family physician friends. You can "shadow" residents and attendings. Is it perfect? No. But, lack of perfection does not justify self induced ignorance and your head under the sand....4. The hours one works in residency varies significantly from 40 or so to 80+, just depends on the specialty, something really only MS-3 and and 4's learn somewhat. It's not til you get to residency that you really learn about the responsibilities you have and the hours it takes. You may see residents working and grasp the general idea but that's not true understanding...
Any undergrad has the choice before med-school. The incomes are no secret. You choose to enter med-school while the pay scale is what it is. That was your choice. Going into med-school and then crying "no choice" is ridiculous....5. You understand the compensation a resident makes. Understanding and acceptance are two different words. Med students don't have a choice in the matter, it's either get your degree and never use it or accept the pay scale. I word argue that's not really a choice.
You stated it as a position of necessity or a position of one being forced. Now that is besides the issue? Even in discussion you seem to want both sides whenever they may suit you....it's actually not reasonable to force trainees to......training ...continues to lengthen with increasing need to super specialize...You can argue all you want about what is necessity vs. want, but that is besides the issue. In all areas of business, talent is attracted by incentives. Case closed.
Yes, your debate, discussion, and rational thinking ability are of the highest caliber. Thank you for keeping your adult wits about you."Supposed to"... according to who? The variation is a matter of choice. You want to do multiple majors and minors, great do it, but understand the time it adds and understand if you have a dream/plan to be a physician you are choosing to add time.As you note, they "decide" (i.e. choose). Which is fine, take time off or double major if you like. That is your choice. The numbers are easy to calculate.
I think I outlined a very simple five point way in which anyone can gaugue the possibilities in my earlier post. You can very easily have a reasonable idea of the lengths of different pathways. And, if someone decides they want to go a long pathway, they should understand they may be giving up other opportunities to pursue this one. It would be nice to say everyone should have every opportunity at every stage and not have to worry about their decisions and the impact on the next stage. But, that is adolescent thinking and not adult thinking. Having an open mind does not require one to be ignorant. In enterring medical school, one should know a primary care track will reasonably take three years after med-school and general surgery can be expectedted to take five years, and any other combinations.Your right, reading and asking questions are not perfect and do not replace first hand experience. Even as a resident, you don't fully grasp the responsibilities faced by attendings or PDs. Still, that does not change the fact that you can look at published information and can speak with residents while you are in HS, undergrad, med-school. You can speak with family physician friends. You can "shadow" residents and attendings. Is it perfect? No. But, lack of perfection does not justify self induced ignorance and your head under the sand.Any undergrad has the choice before med-school. The incomes are no secret. You choose to enter med-school while the pay scale is what it is. That was your choice. Going into med-school and then crying "no choice" is ridiculous.
So, I encourage students to think long and hard about the choices they are going to make. You want to be a physician? Then you should look into what it takes. To be a physician requires completion of medical school and at least some duration of residency. It's your choice. It is an expensive choice. That is the deal.
You stated it as a position of necessity or a position of one being forced. Now that is besides the issue? Even in discussion you seem to want both sides whenever they may suit you.
My responses in reference to choice are clearly not directly addressing worth. They are addressing several individuals' positions that they are somehow forced to do x, y, z. Or, they somehow have an uncontrolled need to do x, y, z and thus based on this force or need should be compensated more. If it is not force, then yes, choice should be considered when one cries unfair and claims that because of x then y reason supports the need for more compensation. If an individual claims force or lack of choice as in part justification for ~compensation, choice must be considered or at least you need to ask if force or lack of choice argument is valid. Not to mention the subsequent extension that claims the training is in someway growing in length.....Jack you suffer from a number of logical fallacies, but the one that I think is pissing everyone off the most is the Irrelevant Conclusion.
Not one of the reasons you list have a logical bearing on what a Resident is worth at any given year of training.
People point this out and you draw another irrelevant conclusion, which in the latter stages of this thread revolve around "choice". ...
My responses in reference to choice are clearly not directly addressing worth. They are addressing several individuals' positions that they are somehow forced to do x, y, z. Or, they somehow have an uncontrolled need to do x, y, z and thus based on this force or need should be compensated more. If it is not force, then yes, choice should be considered when one cries unfair and claims that because of x then y reason supports the need for more compensation. If an individual claims force or lack of choice as in part justification for ~compensation, choice must be considered or at least you need to ask if force or lack of choice argument is valid. Not to mention the subsequent extension that claims the training is in someway growing in length.....
I can appreciate individuals wanting to hit a reset button or retract what they wrote. I have been responding to the comments as they come and my comments are not directed towards all the preceding discussions. If you or anyone else is upset or deem the conversation to be irrelevant then I suggest individuals not start down that path.
If individuals want to continue and declare they are worth some value and thus underpaid, great. I have posed my arguments specific to that and they have posed their arguments to that as well. The issues of choice are in reference to the extraneous that some have tried to employ....
I again say it defies logic for any adult to claim they are "forced" or have no choice in this career path. It defies logic to say any adult could not know how long this path would take. It defies logic to say any adult is forced to not get married or have children. One of the most commonly cited reasons from colleagues in undergrad for not pursuing a career in medicine, "I don't want to be in school/training for 10+ years...".
Dancing...
Who ever said they were forced? And the subject of human freedom is beyond the scope of SDN.
The argument can be reduced to the statement, "residents are worth more than their average salary," regardless of an individual resident's expenses.
The only poster who directly addressed this with relevant examples, from a hospital's POV, was aProg, and his tone betrayed at least a partial concession that residents in the latter stages of their term are worth more than they are paid. "I would rather have a PGY-3 than a PA" and "...they can make it easier for me to bill..."
So, maybe a steeper salary slope would be a reasonable proposal.
Sure, your so coolDancing...
I appreciate the information you provide.
...I realize the impossibility of raising resident's salary, especially in these tumultuous times, and you clearly make sense, but the comparisons to an RN/PA still loom. I guess I think resident care should be reimbursable. You'd think they'd want this to bring in more money. In fact it makes perfect sense to allow a resident MD to be reimbursable as a PA. Does it not? Where would the issue be in this proposition?
And I have a wife and a newborn, so this is a huge logistical issue for me......Does anyone have an answer to the question of the real market value of the care that a resident provides in a year? I bet it's damn near 200k...I just need to see more data, but I'm convinced residents are worth at least 75k.Thanks for all the valuable information.
Sorry for encroaching on your forum, but it's the only way to get solid information about what is certainly the most formidable obstacle to becoming a physician.
I hope at the very least the moonlighting continues, and I guess I'll be happy with the 40-50k and make sure to match Rads with an IR fellowshipYou hate residentsJackAdeli is the Rocky Balboa of SDN. Just won't go down. I'm impressed.
Sure, your so cool
I have found it interesting the way in which you have changed your tune or tone as it were as the conversation progressed. You went from not knowing a residents worth to almost a religious belief in being worth more.
Yeh, sure, you have formulated and evolved in opinion. Thus, better read of your statement is akin to:...The passivising of my stance was a gesture of respect to my exalted Residents and Attendings...
But since my initial outrage and subsequent complacency towards resident's salaries there have been many informing posts, including ...the fact that you just won't die, all of which compelled me to express my ever evolving opinion.
In short, you're not being logical or reasonable ...which makes your stubborn persistence almost trollish...
Can you please change your annoying stupid little AV.