Why do residents make so little?

[colbgw02]

so because your experience has been different, then WS and I must be wrong about ours. got it.

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[Winged Scapula]

i did…the nurses i worked with in residency and as a hospitalist knew our schedules….and they rarely called me for silly orders, but i also got along with the nurses (and many were older nurses who look to take care of "their" docs…i had one CCU nurse that always gave me something to eat when we were on call together). And when I started, we had paper orders….the nurses knew that we would have to come down to write them so…

but as the night float intern, one of the best pieces of advice i got from a senior was to go by each floor early in my shift (or right before i was going to try to get some sleep) and ask if there was anything they needed...

Yes I understand. I got along with the nurses as well and they brought me food too. I too would make 11 pm rounds as well; that stopped some calls but not all.

In my program these calls were not a function of dislike; after all, I was younger, smarter and better looking than most of the nursing staff and yet didn't get any more than my fair share of calls.

 

[Beargryllz]

Residents cost the hospital money. It's not a net plus. If you count in the inefficiency trainees bring to the system, the high level of supervision they require, and their indemnification, paying us ~50,000/yr costs the hospital and your clinical department money.

I don't believe this at all. How about this: residents bill for every single procedure and other thing they do and reimburse the hospital based on the cost of training them. Do you think the hospital would go for that? Or do you think they will continue taking the free labor?

 

[rokshana]

so because your experience has been different, then WS and I must be wrong about ours. got it.

same to you…because YOUR experience is different, I'm wrong?

how about you agree to disagree like WS instead of trying to squash my opinion?

 

[Ronin786]

no one is saying residents don't work hard and long (and to those of us that did residency when interns did 30 hour overnight call or had no such thing as an 80 hour work week, they worked much harder for a lot less), but you are not getting paid an unlivable wage…most of the country lives on a salary less than that of the average resident….and yes, they have debt and raise families on that wage...

I don't understand why you keep bringing this up. The argument isn't whether residents make a livable wage, but whether that livable wage is justified given the amount of work they put in.

 

[colbgw02]

same to you…because YOUR experience is different, I'm wrong?

how about you agree to disagree like WS instead of trying to squash my opinion?

I'm not trying to squash your opinion, and I'm not trying to say that my experience or that of WS is the way it is everywhere. If the nurses at your hospital don't act that way, then that's great, but do you not remember posting these (see below)? You basically said, twice, that there was no way that the nurses could have acted in the manner that I described. It had to be because the interns were out of line. And you persisted along this line even after I said that wasn't the case and even after WS noted her similar experience. You could have just said, "Oh man, that stinks. I've found that to be uncommon and I'm glad the nurses I've worked with never do that", but instead you had to try to convince me that what I experienced didn't actually happen the way I remember it.

that resident probably pissed off the nurse…generally if you aren't a douche to them, that type of behavior doesn't happen…that "fellow" intern was being taught a lesson.

i think there are some calls that can be placed on that…but his example of a soon to be expired prn order? thats because the nurse doesn't like that intern...

 

[circulus vitios]

This. It's extremely naive to suggest that $120k comes in and $45k goes to the resident so somebody is making bank. In actuality, it's a net loss to most academic institutions for the "privilege" of being a Teaching hospital. The government money is an enticement to make this more palatable, because frankly the outlay of med mal insurance costs, GME staff, and the slowing down of attending who are now spending some of their very valuable time teaching rather than billing, is not insignificant. even with this government outlay, many places opt to forego having residents because it's such a money drain.

You believe that each resident costs the hospital in excess of $75,000 a year for every year of training i.e. senior resident labor is of absolutely no value and does not offset any inefficiencies in a resident's more junior years? That's ridiculous.

 

[rokshana]

I don't understand why you keep bringing this up. The argument isn't whether residents make a livable wage, but whether that livable wage is justified given the amount of work they put in.

no the original question is why are residents paid so little…little to what? related to attending pay? or to the regular person?

there are plenty of people who do work as much as residents do in the terms of hours…60 hour work weeks aren't uncommon…and get paid about the same, maybe a bit more, and some times even less…

the wage is livable so you're not exactly a slave or free labor….we are just lucky enough that 60K is not the top wage...

 

[BlondeDocteur]

I don't believe this at all. How about this: residents bill for every single procedure and other thing they do and reimburse the hospital based on the cost of training them. Do you think the hospital would go for that? Or do you think they will continue taking the free labor?

Ah, but you can't bill. You're not board-certified. You have to be supervised and overseen and have someone sign off on, and take the fall for, your work. If you were BE/BC and stuck in a resident-like contract then you'd have a case.

 

[deleted128562]

Alright folks, I've been put in my place and must now agree that residents are losing hospitals tons of cash and that academic centers would be better off burning stacks of money in the parking lot than continuing to have residents. So in summary:

1) Newly minted doctors working 60-80 hours/wk, even with their full salaries and benefits paid for by Uncle Sam with $40-50K still left over for the hospital, are a drain on the hospital system.

2) Newly minted NP's and PA's who work 40 hours/wk and are paid $80K plus benefits directly by the hospital, are a net benefit to the hospital system.

3) As we can see from above, new mid-level practitioners are worth at least $200,000 per year more to a hospital than a new physician.

4) Therefore, it seems that medical schools are producing a bunch of worthless *****s in twice the time that mid-level schools are producing pretty competent practitioners.

5) I can no longer in good conscience argue with my PA and NP friends that they shouldn't be able to compete for ACGME residencies. I mean, if they are already more competent than a new physician coming in, then imagine what they could be after a residency.

6) Medical schools are horrifically inefficient rip-offs and should all be bulldozed into the ground. The PA and NP training model should be the new standard of medical education, with residency optional to become a supervising provider.

 

[Chickenandwaffles]

Alright folks, I've been put in my place and must now agree that residents are losing hospitals tons of cash and that academic centers would be better off burning stacks of money in the parking lot than continuing to have residents. So in summary:

1) Newly minted doctors working 60-80 hours/wk, even with their full salaries and benefits paid for by Uncle Sam with $40-50K still left over for the hospital, are a drain on the hospital system.

2) Newly minted NP's and PA's who work 40 hours/wk and are paid $80K plus benefits directly by the hospital, are a net benefit to the hospital system.

3) As we can see from above, new mid-level practitioners are worth at least $200,000 per year more to a hospital than a new physician.

4) Therefore, it seems that medical schools are producing a bunch of worthless *****s in twice the time that mid-level schools are producing pretty competent practitioners.

5) I can no longer in good conscience argue with my PA and NP friends that they shouldn't be able to compete for ACGME residencies. I mean, if they are already more competent than a new physician coming in, then imagine what they could be after a residency.

6) Medical schools are horrifically inefficient rip-offs and should all be bulldozed into the ground. The PA and NP training model should be the new standard of medical education, with residency optional to become a supervising provider.

Haha, my "feelings" exactly. I just had this conversation with someone today. This happens because medicine is like the mafia, and programs just can do it, since we cannot practice without a residency. Some people say, well you guys can't practice independently. Really? Well neither can nurses, or PA/NPs who will NEVER practice independently and carry out the orders of doctors forever.

Should we be paid 400k straight out of med school? No, of course not. But probably 75k + would be reasonable.

 

[Chickenandwaffles]

Ah, but you can't bill. You're not board-certified. You have to be supervised and overseen and have someone sign off on, and take the fall for, your work. If you were BE/BC and stuck in a resident-like contract then you'd have a case.

PAs and nurses also have to be supervised. Do you think that a PA with 2 years of post college education knows much of anything? They will ALWAYS have to be supervised, and any screw up that they are responsible for will not be their fault, and they start in the 70k + range. They also work 40 hrs.
How does that make sense?

Most residents within a year or less are pretty much working quite independently, except for certain surgical specialties.

 

[BlondeDocteur]

Hey, preaching to the choir here on the relative skillsets and knowledge bases of a midlevel v a resident. However, the midlevel has completed their education and passed their licensing exams. They're PA-Cs (Certified) or ARNPs. They can bill under their own name. They make enough money-- independently-- to justify their salaries in the eyes of the hospital. We can't do that.

What I hear you saying is that the added value provided by a PGY-2 over an intern, an R3 over an R2, etc is more than the $3000 or so salary differential we get each year as we go up the ranks. Which seems reasonable, but again you run up against the fact that a seasoned chief resident a month shy of graduation is no different than an intern in terms of billing.

 

[Raryn]

Alright folks, I've been put in my place and must now agree that residents are losing hospitals tons of cash and that academic centers would be better off burning stacks of money in the parking lot than continuing to have residents. So in summary:

1) Newly minted doctors working 60-80 hours/wk, even with their full salaries and benefits paid for by Uncle Sam with $40-50K still left over for the hospital, are a drain on the hospital system.

2) Newly minted NP's and PA's who work 40 hours/wk and are paid $80K plus benefits directly by the hospital, are a net benefit to the hospital system.

3) As we can see from above, new mid-level practitioners are worth at least $200,000 per year more to a hospital than a new physician.

4) Therefore, it seems that medical schools are producing a bunch of worthless *****s in twice the time that mid-level schools are producing pretty competent practitioners.

5) I can no longer in good conscience argue with my PA and NP friends that they shouldn't be able to compete for ACGME residencies. I mean, if they are already more competent than a new physician coming in, then imagine what they could be after a residency.

6) Medical schools are horrifically inefficient rip-offs and should all be bulldozed into the ground. The PA and NP training model should be the new standard of medical education, with residency optional to become a supervising provider.

If anyone else wants to respond to this rather ridiculous understanding of the valid points made during this thread, the poster actually opened a separate thread over in allo: http://forums.studentdoctor.net/threads/maybe-pas-and-nps-should-be-allowed-to-do-residency.1069652/

 

[Law2Doc]

You believe that each resident costs the hospital in excess of $75,000 a year for every year of training i.e. senior resident labor is of absolutely no value and does not offset any inefficiencies in a resident's more junior years? That's ridiculous.

Um no, if you read my posts on this thread I said something somewhat different. I said seniors were absolutely generating value, but that most programs (eg surgery plus medicine -- constitutes the majority of residents) were pyramidal (bottom heavy) in structure (thanks to prelims), such that the few seniors efficiency could never ever balance out the many more interns inefficiencies. just as the seniors start to get really valuable, they graduate. That's why residents are a cost overall, even though by the end some become quite valuable. (It pays to actually read people's posts in a thread before you call them "ridiculous".)

 

[deleted525628]

...most programs (eg surgery plus medicine -- constitutes the majority of residents) were pyramidal (bottom heavy) in structure (thanks to prelims), such that the few seniors efficiency could never ever balance out the many more interns inefficiencies.

Umm... surgery programs are pyramidal at the preliminary intern level because they need someone to do the crappy scutwork that they can't find an NP to do eg. night call, pre-round, preop patients. Eg. Baylor has 6 or so categorical surgery spots and 16 prelim surgery spots. These surgical prelims aren't guaranteed a PGY2 year in the program so it's not like there's some awesome prestige involved in "teaching" these surgery prelim interns. If you think it costs so much for hospitals and programs to have "inefficiencies" by supervising prelim surgery interns, why don't programs cut undesignated prelim surgery spots? They can't because it would cost them 2 NPs for every surgery prelim cut.

 

[NotAProgDirector]

Whether residents "make" or "lose" money for an institution will depend on the program and the institution. In general, I expect that most programs make money or break even.

1. It will depend upon what the residents actually "do". In programs where the residents function autonomously and faculty simply bill for their procedures / time / work, it will be a big plus. In programs where all residents are directly supervised by faculty in all that they do, it will be a wash (in general).

2. It depends on the institution. Per resident funding varies widely between institutions. DME is all the same, but IME is crazily different -- often 10x different.

3. It depends upon how residents would be replaced. For example, at my IM program we have both a resident and a faculty member available for admissions overnight. Let's pretend that all of the residents went on strike tomorrow -- what would we do? One option would be to have 2 faculty on at night -- this would obviously be much more expensive. Another option would be to have the ED write admit orders for 1/2 the patients -- this would cost almost nothing. For sure, replacing residents with anyone else would be a financial loss, but any program that actually loses their residents is likely to change the way they work, to mitigate that cost.

4. There are other costs to residents. My residents have 6 months of elective time in their final year. if I hired midlevels, they don't get electives -- they work on service all the time. Then you need to pay for the GME office and staff, ACGME fees, recruiting costs (presumably lower without residents, since the turnover drops), etc.

Overall, training residents is probably a financial good deal for most programs. But it will depend upon many factors, and what you "count" in the budget.

 

[P Diddy]

Umm... surgery programs are pyramidal at the preliminary intern level because they need someone to do the crappy scutwork that they can't find an NP to do eg. night call, pre-round, preop patients...

This is incorrect; at my institution NPs serve night call in the ICU, pre round, and pre-op patients. They often do the less intense, 'mindless' work (routine chemotherapy admits) which I think is great; less for physicians to do.

I see the pyramidal system as originally constructed to weed out those who didn't succeed in surgery, with those who didn't advance in the past going on to other specialties. As surgery's allure/work-life balance dwindles and other specialties become more attractive, I would guess it's harder to fill those prelim positions with only the truly desperate (FMGs) applying.

p diddy

 

[Law2Doc]

Umm... surgery programs are pyramidal at the preliminary intern level because they need someone to do the crappy scutwork that they can't find an NP to do eg. night call, pre-round, preop patients. Eg. Baylor has 6 or so categorical surgery spots and 16 prelim surgery spots. These surgical prelims aren't guaranteed a PGY2 year in the program so it's not like there's some awesome prestige involved in "teaching" these surgery prelim interns. If you think it costs so much for hospitals and programs to have "inefficiencies" by supervising prelim surgery interns, why don't programs cut undesignated prelim surgery spots? They can't because it would cost them 2 NPs for every surgery prelim cut.

I'm saying that the federal money makes prelims an affordable option, but barely. The intern himself certainly costs more than he generates, but the feds have stepped up and thrown cash at the problem, to make the undertaking viable. Still doesn't make the kind of money the hospital could make if it went private and doubled the OR time like the private shop across the street. my point is these interns aren't making the hospital money. They are a cost center, but there is some cache value in being an academic center, so places do it, and the federal money makes it palatable. But if you think the intern should be making $80k because the subsidy they come with is eg $120k (or whatever the subsidy is currently), you really aren't grasping the economics of the situation. the amount isn't $120k to line someone's pockets, it's eg $120k because it wasn't worth it to hospitals to do it at $110k. And those numbers are really averages, meaning the intern is averaged with the more productive senior to decide the per resident value. So you are getting some Value with the senior and closer to a loss with the intern. The subsidy came into being because it tipped the scales ever so slightly, and made being an academic center doable. Don't try to rewrite history and pretend it was done to line some administrators wallets. The ACGME hurdles, insurance and teaching obligations are really not worth jumping through for less.

 

[core0]

Whether residents "make" or "lose" money for an institution will depend on the program and the institution. In general, I expect that most programs make money or break even.

1. It will depend upon what the residents actually "do". In programs where the residents function autonomously and faculty simply bill for their procedures / time / work, it will be a big plus. In programs where all residents are directly supervised by faculty in all that they do, it will be a wash (in general).

2. It depends on the institution. Per resident funding varies widely between institutions. DME is all the same, but IME is crazily different -- often 10x different.

3. It depends upon how residents would be replaced. For example, at my IM program we have both a resident and a faculty member available for admissions overnight. Let's pretend that all of the residents went on strike tomorrow -- what would we do? One option would be to have 2 faculty on at night -- this would obviously be much more expensive. Another option would be to have the ED write admit orders for 1/2 the patients -- this would cost almost nothing. For sure, replacing residents with anyone else would be a financial loss, but any program that actually loses their residents is likely to change the way they work, to mitigate that cost.

4. There are other costs to residents. My residents have 6 months of elective time in their final year. if I hired midlevels, they don't get electives -- they work on service all the time. Then you need to pay for the GME office and staff, ACGME fees, recruiting costs (presumably lower without residents, since the turnover drops), etc.

Overall, training residents is probably a financial good deal for most programs. But it will depend upon many factors, and what you "count" in the budget.

One thing this ignores is payor mix. Depending on the payor mix residents can be a good deal or a bad deal for a hospital. Fundamentally there are three situations.
1. County type hospitals. Large amounts of "self pay" and Medicaid with the rest Medicare. Little or no private insurance.
2. Academic Medical Centers - Mix of insurance. Lots of Medicare with private payors drawn by the resources or referrals. Some Medicaid and Self Pay.
3. Suburban Community hospitals - Lots of private practice with some Medicare. Little or no Medicaid or "self pay".

This kind of defines the bottom middle and top. There are exceptions. Academic Medical centers such as Mayo Jacksonville or Cleveland Clinic may have payor mixes that resemble suburban hospitals (no actual knowledge just anecdote). A county hospital with lots of non penetrating trauma may have a better payor mix but most cities resemble the county hospital model.

So look at the financial models (I'll use examples from my metro area) Medicare RVU = $34.
1. County hospital - RVU = $14-20. Residents are the majority of the workforce and hospital could not function without them. Some Non-physician providers (NPPs) which don't cover half their salary.
2. Academic Medical Center RVU = $39. Residents are still a majority of workforce but NPPs present. From a financial standpoint NPPs cover their salaries with slight profit in some departments.
3. Community hospital RVU = $50-70. Minimal resident coverage (rotating residents from other programs). From a financial standpoint NPPs with a 0-30% profit.

This is effectively the answer to why residents aren't paid more. Residencies are overwhelmingly concentrated in case 1 or 2. For Case 1 especially the removal of residents would cause the hospital to close or severely reduce services. If you increase resident pay you have to cut services elsewhere. For the other cases the increase in pay for residents turns break even into money loser or decreases profit in institutions who have minimal activity anywhere.

Essentially residents in many cases represent a subsidy that allow hospitals to treat under insured or non-insured patients.

 

[Bacchus]

i did…the nurses i worked with in residency and as a hospitalist knew our schedules….and they rarely called me for silly orders, but i also got along with the nurses (and many were older nurses who look to take care of "their" docs…i had one CCU nurse that always gave me something to eat when we were on call together). And when I started, we had paper orders….the nurses knew that we would have to come down to write them so…

but as the night float intern, one of the best pieces of advice i got from a senior was to go by each floor early in my shift (or right before i was going to try to get some sleep) and ask if there was anything they needed...

Can't stress this enough.

 

[Bacchus]

Signed my pgy2 contract. Was quoted last year's pgy2 salary. May increase 2%. Anyway, 55700 come next year. Not bad.

 

[da8s0859q]

Signed my pgy2 contract. Was quoted last year's pgy2 salary. May increase 2%. Anyway, 55700 come next year. Not bad.

What part of the country? Anyway, congrats. We haven't done ours yet.

 

[Bacchus]

What part of the country? Anyway, congrats. We haven't done ours yet.

Somewhere in not so rural PA.

 

[DermViser]

Not necessarily.

Many nurses have no idea that you aren't working an 8 hr shift and so think any phone call in the middle of the night is "fair" regardless of their feelings about the resident. Once I educated the nurses about our schedules these nuisance pages dropped dramatically.

I was quite amazed at nurses who had worked for decades who still didn't understand how many hours residents put in. That being said, VA nurses are idiots who don't care about anything except not getting in trouble., so there's that.

 

[keifernny2]

Somewhat fitting to this topic..and hot off the presses.
The Economics of Graduate Medical Education
Amitabh Chandra, Ph.D., Dhruv Khullar, M.D., M.P.P., and Gail R. Wilensky, Ph.D.
May 14, 2014DOI: 10.1056/NEJMp1402468

http://www.nejm.org/doi/full/10.1056/NEJMp1402468

 

[HoboCommander]

The hospital gets subsidized $120k annually per resident. Additionally, the hospital is paid a second time when the resident generates the hospital money, though this amount would really vary between PGY-1 versus PGY-5. On the open market, aka moonlighting, residents can make $80-100 per hour so that gives you an idea.

So if you add the resident subsidies to the profit directly generated by the resident, it could easily exceed $200k a year for the hospital. This is why so many residency spots are opening on their own, without the subsidies.

 

[rokshana]

Why did you bump this year old thread with the same level of naïveté as the very first post? Did you even bother reading any of the very informative posts (and links)?

really? you really expected some necro-bumper to ACTUALLY read the posts in the thread before making some silly comment?

 

[ThoracicGuy]

 

[serimeri]

For some of my friends, with $200K in loans, I certainly hope that loan forgiveness and tax forgiveness on remaining amount will be in place still.

Some of these poor chaps are making $44K per year in county type facilities, working 2X as much as I will (patient volume, lack of other providers) etc.

For these people, it'll probably be better to just go ahead and do the PSLF for 10 years.

 

[Obnoxious Dad]

If you want to get a better handle on residency salaries, funding, costs and policy read the report issued by the Institute of Medicine. Here's the link:
http://ldihealtheconomist.com/media/gme-iom-2014-report.pdf

The fact is residency program directors do not know if they are saving or losing money on residency programs. They do a poor job of data gathering and no one knows if the configuration of their programs is efficient. Because hospitals are creating unfunded residency slots at a rate of approximately 200 slots per year, I suspect that efficiently managed residency programs in fields where residents render in house services such surgery, internal medicine, pediatrics etc are money makers for hospitals. The behavior of these institutions is much more persuasive than the propaganda of residency program directors and deans.

 

[Crayola227]

3-4 weeks vacation per year is more common in ACGME programs, so;

$48,000/80 hrs x 49 weeks = $12.25/hr.

Now back in the day....

Glad we corrected the pay from around $9 per hour to $12.25. I feel so much better already Just giving you a hard time Winged Scapula.

The values may have changed, I think I figured out that I was getting like $25 per hour pre-tax and whatever, and saw a posting at my hospital for a security guard at like $22. I'm not going to say considering a job change didn't cross my mind. It actually put a spring in my step because I thought it was hilarious I was as "valuable" to the hospital as a security guard (not saying they're not valuable, but it was nice to know that if residency doesn't work out there's a job opening there).

The point of a union is to provide strength through collective bargaining that is absent in individual bargaining. They're useful for skilled employees whom employers might otherwise view as interchangeable. However a union still requires bargaining chips to be effective. If you can't play one employer off another, or threaten the employer when they refuse to negotiate, then there's no point in unionizing. More succinctly: if you can't strike there's no union.

Residencies collaborate with one another in a way that would be termed a trust in any other industry. Actually its considered a trust in this industry, its just that medical training, like Major League Baseball, holds an exemption to anti trust laws. Anti trust laws, as well as labor laws (which we are also mostly exempt from) are what prevent corporations from stoping the threat of unionization by colluding to destroy employees who threaten to unionize. When employers are allowed to collude to blackball any employee who participates in any kind of meaningful protest (like striking, or refusing to bill for services) then the 'union' is basically nothing other than a house staff council that you need to pay dues to. You elect your representatives, they bring your complaints to the administration, and the administration does whatever they want to do.

Yes they have formed a giant cartel to control salaries. They collude to hire you through a giant centralized process to make sure that no one ever gets offered anything more than everyone else. They collude to blackball you if you quit or are fired, ensuring that a resident can't quit a job for one that's more lucrative or humane. They have conspired to lobby for one of the greatest feats of regulatory capture in American history: convincing the government to pay 100% of the salaries of their employees. These are all practices that are illegal in any other industry, and they are the classic characteristics of a trust.

I didn't set out to quote Perrotfish so much, but that's just what happens because I love like everything they write.
AProgDirector pointed out that unions would probably have the greatest benefit to the resident group that gets the worst possible shaft ever: termination.

Having residents where they have residents is clearly sustainable where they have them or they wouldn't be there. Yeah, not the most profound argument, I get that.
I don't really give a damn if the program is pocketing tons and tons of money while I make $50K, assuming that were even the case. I'm glad to get training. I don't mind my salary, for a single person at least where I live, I live what I think is very comfortable but I grew up poor. Granted, I'm on IBR so my loans are growing while I live in luxury. I could probably support a stay at home boyfriend to pick up my dry cleaning on that too, and we'd be OK. Luckily I work too much to play too much and spend much and I don't have expensive hobbies anyway. I live in a very nice apartment, drive a used car I own outright that is reliable and I like, I can buy whatever food I want, afford to go out to eat at nice restaurants on occasion, and have high-speed internet and Netflix. I can keep my apartment as cool and as warm as I like. I can take a reasonable travel vacation with my little vacation time. I can buy clothes I like new from a department store. I'm not buying $300 boots but I can wear $90 Guess jeans I really like. That's a lot better than probably some huge percentage number I'll pull out of my butt like 75% of people in the world or like 60% of people in the US. Whatever. I'm not saying I want to make this kind of money forever, I'd like an attending salary and a nice big house and some kiddos and maybe fancier vacations. And lessons for the kids to pursue their dreams. And a nice nest egg.

What bothers me more is that somehow other countries are able to train residents to be competent, and they can get paid more, have more benefits overall in that society, and work more humane hours, all while being without such crippling loans.

So I guess I'm saying I don't know that residents make so little, maybe they could make more. Maybe they deserve more. Dunno. The crippling debt makes our salary a little less palatable.

Residents make "so little" or whatever because there's like 100 million factors to that, and if there were a total overhaul of our societies infrastructure, not saying that's practical or going to happen anytime soon, I'm convinced we could shuffle money around or tax some rich politicians at a higher rate or something and change laws like around malpractice or something, and create a system that, yeah, might pay residents more, or, maybe more importantly, reduce their loans, improve their hours, improve training, patient care, the health of the country as a whole, the size of the physician workforce, and a lot of things that are very hold-hands-round-the-campfire-and-sing-kum-by-yah. Most of the issues with healthcare are the distribution of dollars and man hours. If our society used its resources differently, maybe that magic fantasy could happen. Or not. Whatevs.