Fun With Numbers
80 hours: Twice what a regular “full time” job requires you to work. Yet, 80 work hours per week is considered “too lenient” by some standards.
- There are 168 hours in a week.
- 80 hours is 47.6% of 168. You’re working for damn near half of the week.
- One day off in seven says you need to get your 80 in six.
- This means you’ll average 13.3 hours per day for 6 days a week.
- A first-year resident makes $38,000 - $42,000. Let’s use $40,000.
- With days off, a resident will work in the ballpark of 4150 hours per year.
- With a salary of $40,000 per year, this is equivalent to $9.63 per hour - before taxes.
- The federal minimum wage is $5.15 per hour.
- A resident’s salary is 1.87 times the federal minimum wage.
- The average citizen in the US sleeps 6.9 hours per night.
- After sleep and a regular work day, you’ll have exactly 3.8 hours per day to spend with your family, eat, shower, drive to and from work, buy groceries, pay bills, wash clothes, go to the bathroom, have sex, watch the news, read, study, cook, and live.
Have fun.
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Cherokee said
April 17 2007 @ 2:45 am
One of your best posts, Hoover. I am humbled in your presence!
Garrett said
April 17 2007 @ 8:44 am
Don’t worry, nobody has sex during residency anyway. That frees up an extra 4 minutes on your week.
I thought I’d practice the non-sex thing by getting married after M1 year. So far, that’s been a three-year running success story of non-sex.
Smith said
April 17 2007 @ 9:58 am
Hi, I’m writing from England. Haven’t posted on your blog yet but have been following for a while. I’m planning to go into medicine and have been looking for a good english med school blog. So far i’ve only found yours and another one that has stopped being added too (http://hippocraticoaf.blogspot.com/). You seem to have a shitty time to be honest as a Doctor of the USA. I’ve seen the state of British Hospitals and although they are facing a crisis, i’m not sure they are at the same stage as USA hospitals. Your blog has intrigued me because it has helped to give me a realistic image of medicine, not the fancy angelic one of saving lives, being rich, having a great life…
Thanks for writing your blog, and i hope you continue.
P.S. Garrett get laid!!!
Jared said
April 17 2007 @ 1:28 pm
Way to go Garrett. Way-to-go.
Hoover said
April 17 2007 @ 1:28 pm
Smith, thanks for the compliments and be sure to check out Panda Bear’s blog at pandabearmd.com.
Panda Bear said
April 17 2007 @ 2:15 pm
Whoa there Smith. Regardless of the general crapulence of residency training, even ordinary American Hospitals are light-years ahead of almost anything you will find in the rest of the world. That’s why we spend so much on medical care as a percentage of GDP.
The little Parish Hospital in my home Parish (county) in my native Louisiana, the poorest state in the United States and the most “backwards” (but I will kick the ass of anybody who says it)) makes the best public hospital in Greece (my ancestral homeland and where my mother lives) look like an Urgent Care in Sistercouple, Arkansas.
I dare say it would give most British hospitals a run for their money.
Not busting down on you. Just pointing out that I have friends in Greece and France who are physicians and who are amazed at the level of care we give to homeless winos living under a bridge who, quite frankly, would be allowed to die of their many comorbidities over there. (Yes, the French do have homeless winos)
Panda Bear said
April 17 2007 @ 2:18 pm
And I may quit blogging because I think Brother Hoover has it pretty well sewn up. I feel like I’m just garnish compared to Medschoolhell.
Someone interested in medical student and resident education said
April 17 2007 @ 3:52 pm
hoover,
You have a great blog. You bring up a number of points that are extremely well taken by the masses and I, trying to effect change in a system that changes like molasses in a Maine winter, like reading this to see what some of the general sentiment is about residency etc… I find the “80 hr work week” as being a hot topic that many people like to discuss. Does anyone ever talk about patient care? Say, if a patient is coding do I leave because my shift is over and I am tired or do I stay? May be that isn’t a fair question.
A discussion I had with a pediatrician today about the changes in the resident mentality that he is seeing. He asked the question, “Are we are not preparing people for practice?” I questioned why he would make such a statement. He said that so many after residency have become disheartened with their practice. His thoughts were that we are not giving people the proper “real life” experience. I think he may be onto something. I do believe that many feel that the road become somewhat greener when you complete residency, but it brings on another set of problems. The business of medicine can get you down. You realize that the slice of pie is not that big and to make the “money” you have to put in plenty of hours on non medical issue and “scut” as you may call it.
The problem with the 80hr work week is that now we have now placed a number on amount a resident is allowed to work. It’s kind of like the 55 MPH speed limit; some will obey it and some will risk the ticket (fine). Now, we can calculate how much per hour you will make. We can right articles about how much time people spend in hospital and time away from their families. People who have trained in the past can say you are not as good because you did not work as hard as I did. Bottom line; give good patient care regardless of the time. In practice, that is what matters in the end. For me, I can’t really speak for the “man,” I try to get my residents and medical students to feel a sense of pride in what they do. I want them to concentrate on giving good, appropriate care. Sometimes we get home early; other times, not so much. My feeling is you should do what you feel is “right.” I can say this because I know my residents are within the hour limits. You may ask, how would I know that. Because I am usually here when they leave answering phone calls and filling out paperwork.
Hoover said
April 17 2007 @ 10:28 pm
With real life versus residency, we’re talking about an enormous pay difference. I’m sure people would be willing to stay at work after hours if they were making 5-6 times a resident’s salary. I bet people would be willing to stay past 80 hours even for a bonus such as double-time on their next paycheck. That double time needs to be after 40 hours.
The problem with the 80 hour work week is that so much of that time is wasted and the resident has absolutely zero incentives for staying late.
The solution to the problem is relatively simple: Programs need to become efficient. From observing the medical training process as a student, it is the most inefficient and wasteful method of training I have ever seen. I thought other government jobs were wasteful, but they don’t hold a candle to the amount of time and money that’s wasted at academic training centers.
A hospital and training center should run like a traditional business. How much money do you think Microsoft or Google wastes? Google is posting profits of 3.1 billion per quarter. You can’t do that being inefficient.
I know comparing Google to medical training is like comparing apples to oranges, but the message is the same: Inefficiency is a poor business decision, and the most profitable businesses are efficient.
But is medicine a business? Absolutely. Hospitals need to turn a profit or they’ll shut down. It’s as simple as that. The problem with academic training centers and inefficiency is a complex one, but the root is easy to find.
Academic training centers have long relied on cheap resident labor to survive. Over the years, they have become lazy and have been allowed to survive (if not thrive) on inefficiency. They can afford to be inefficient due to the poor salaries that they are paying these residents. The process simply repeats itself every year as the hospital obtains fresh labor at a large fraction of their normal cost. Round and round we go…
They cut corners and scut out meaningless paperwork to residents. Why? Because they’re paying them $9.63 per hour. Chances are they’d have to pay a secretary more than that to do that level of work. So can’t you see that the inefficiency is actually built into the system?
I think Panda mentioned in a comment somewhere that soon we’ll see civil penalties and lawsuits that come out of duty hour standards violations. Just like he mentioned, you’ll see hospitals become efficient overnight. I agree with this 100% Once their hands are tied they’ll have no choice but to shape up. I honestly hope it comes to this.
With the current situation, hospitals can be lazy and inefficient. Duty hour standards violations aren’t being taken seriously enough. Fines are bullshit. They need to start yanking accreditation for 5 years at a time. Let’s start making the punishment fit the crime.
Once they realize they can no longer get away with this crap, you’ll see programs not even needing to work residents for 80 hours per week because they’ll become lean, mean, efficient machines.
Someone interested in medical student and resident education said
April 18 2007 @ 9:06 am
i love the argument about inefficiency. where does the inefficiency come from? is it the training? or is it the trainees?
the medical system in itself is inefficient. i have been fortunate to experience the medical system on multiple levels. lets talk about levels of inefficiency. if you look at just the medical field the most efficient would be a private hospital without resdients and only PA’s and NP’s with physicians. next would an academic medical center. the would come the most inefficient VA and military medical system which makes the inefficiency in academics seem like they are going lightening fast.
people speak about making medical training more efficient. the inefficiency in an academic hospital, say in my OR, comes from the resident surgeon. how to make the process of adult learning any quicker? my partner says repetition is the key to adult education. i think he is probably right.
people make suggestions on how to make things more efficient. i ask what would you recommend? (this is not sarcasm genuine question) as for the inefficiencies in hospitals, what would you recommend? i can tell you from personal experience that every hospital i have ever worked at has inefficiency. clinical training is a difficult one. how do we give to enough training so that you won’t hurt people? clinical skills can not be read, they have to be practiced. how do we teach you how to document appropriately so that you meet guidelines for E&M coding?
again, i will say our residents are well under the 80hour work week. and i said on Dr. Bears site, that i would prefer my PA to a chief resident (in my clinic, our PA’s don’t go to OR). he of course blasted me speaking about leadership and so forth. but, if we are talking about efficiency, it is more efficient for me to have a PA than a resident. it doesn’t mean i don’t like my residents or don’t want to lead them. but, a resident new on service has to relearn all the little things that make thing more efficient. they also have only book knowledge an have no practical experience on how to apply it.
as we concentrate on the 80hr work week, there are many programs who are changing as i may have mentioned before. my view is biased because we are sticklers for the rules. the thing that gets lost for me is the patient care part has been lost in the discussion. i will state now my ignorance about how the medical services run.
oh and do remember that the hospitals themselves do not control the residents, that comes down from the department/devision heads.
Midwife with a knife said
April 18 2007 @ 9:39 am
I think a lot of the inefficiency comes from the random paperwork that the hospital requires. Inefficient and cumbersome EMR systems that are designed for accountants and billers, NOT for patient care.
As an example: where I was a resident, when they introduced a computerized discharge instruction system, the NPs refused to fill out the discharge instructions for patients, so each discharge (which in this retarded system took 15 minutes, which is a huge problem for the intern on a high turnover service like L&D) had to be done by a resident. There’s 0 learning in filling out those forms, and requiring a system be used that makes the process of discharge take longer is something the hospital can only do to residents (as made obvious by the fact that the NPs refused), and it takes away time that could be spent learning.
The other issue is that nurses often feel free to harass residents with things that should be taken care of during the day. There’s no excuse for calling someone on a 24-30 hour call at 3am for a colace order! Obviously fevers, hypertension, bleeding all need to be dealt with, but nurses should learn to pool non-urgent calls and to limit non-urgent calls to before 12am and after 5am.
Clearly, nobody’s going to leave a coding patient because their shift is up, but at the same time, because resident time has typically been treated with 0 respect by hospital administrators, nurses, and to some extent attendings (although I’ll happily do meaningless scut for an attending who teaches!), resident learning time has become ineffecient.
Someone interested in medical student and resident education said
April 18 2007 @ 9:48 am
quick statement on the EMR systems. although it seems like no learning, there is learning. those systems are specifically set up to meet guidelines for E&M coding. Even the military has an EMR system (ALTA) and it is extremely cumbersome. for the billing end (business), you need to understand what is important to document and what is just fluff. most of the new EMR systems have the check and balances built in. because when you get into practice, your practice will be audited and notes review to make sure you have coded correctly. i agree the the EMR systems (most) need to be stream lined.
Panda Bear said
April 18 2007 @ 10:58 am
The most ridiculous thing I was routinely asked to do as a resident?
Even though I don’t speak or write spanish, having to hand copy lengthy disharge instructions off of a laminated template onto another form (you know, the usual boilerplate that nobody reads and our illegal alien patients would ignore anyways.) We couldn’t just copy the template because the service wanted it on the standard discharge form and there were blanks in the template we had to fill.
This took about fifteen minutes per patient. The nurses wouldn’t do it because they had some self-respect and the the PAs wouldn’t because they could quit and find another job fairly easily so they made the slaves do it.
Hoover is absolutely correct about the inefficiency of medical training. And it’s not just iniefficinet because medicine itself is inefficient. Do you think a “real” doctor in a “real” hospital who was costing the hospital real money for his time would be expected to waste an hour or two a day doing something like that? I’ve been to “real” hospitals. They are nothing like teaching hospitals in this respect.
I repeat, most vehemently, that if any program including surgical specialties can’t provide adequate training for thier residents when given 80 hours a week in which to do it, well, that’s almost criminal inefficiency which, as Brother Hoover points out, is only made possible because there is no penalty for it.
The Man defends the system because a)He’s used to it and change is difficult, b) He’d rather keep his costs down, c) He had to go through it and it is the nature of mankind to want revenge, and d) He doesn’t care because he’s not losing any sleep over it and he’s getting paid jsut fine, thanks fer’ asking.
Someone interested in medical student and resident education said
April 18 2007 @ 11:58 am
i guess i am part of the “man”. i, as when in power positions, like to keep the brothas down, using my native ebonics. i would not defend it. i woud like to change it. how do we effect change? i could complain about it. doesn’t really make a difference. i could jump up and down and throw instraments. in my experience, that just gets you written up by the nurses. or, i can work within the system to effect change. i chose not to swim up stream.
we can complain about meaningless paperwork, i would agree (the FMLA is my least favorite). we can complaint about little pay, reimbursements going down everyday insurances paying a % of medicare (94% of medicare, etc.) we about the experience and inefficiencies of medical training.
question, how do we make it more efficient? how do we ask for patients with certain illnesses come into the hospital so you can receive that experience? i don’t know the answer, i look at every day as a school day. i learn as much from my residents and medical students as they learn from me. so, to all how do we make it more efficient? you say less paperwork. i will say in on my service, done. we have 2 PA’s and an NP and 2 secretaries, this is to support 2 1/2 attendings and 3 residents and a out patient volume of 9500 pt visits per year. lets move on to the next point, so how do we make the education portion more efficient with a majority of paperwork being gone? i can tell you that even with less meaningless paperwork gone, they done learn any faster.
Someone interested in medical student and resident education said
April 18 2007 @ 12:29 pm
that that is they don’t learn faster.
midwife with a knife said
April 18 2007 @ 1:45 pm
I think that’s the big question. How do we change it? I don’t object to all scutt. A certain amount of scutt is part of medical practice. But certain things (like recopying discharge instructions) is really an abuse of the time of trainees and certainly detracts from training.
The idea/social contract of medical training is that we’re supposed to be willing to provide service (which includes uncompensated/indigent care, helping the attending by taking calls from nurses/patients/etc) and put up with low wages (aka a “stipend”) in order to get good medical training.
I actually think that’s a fair deal, if that is what is happening. However, when certain abuses of residents’ time (like filling out forms that could be filled out by a nurse or secretary if only the hospital had the gumption to make them) INTERFERE with our education and training (which spending 2 hours a day on discharge instructions certainly does), that’s a violation of the social contract of medical training.
I think that people hoped that by limiting resident’s hours, it would make those hours seem more valuable, and therefore less likely to be abused (i.e. if you now only spend 80 hours/week at work, it’s even more important that those hours be spent LEARNING instead of spending hours navigating foreign language discharge forms (which, really, Panda, the hospital should have just printed up a thousand copies for the MD to sign). That hasn’t been the reality or most people’s experience. What now happens is that junior residents/off service rotators spend all of their time doing the 2 hours of Spanish discharge instructions so that the senior residents get some OR time and some time to actually learn. That’s not a great arrangement.
sam houston said
April 18 2007 @ 1:48 pm
“i can tell you that even with less meaningless paperwork gone, they done learn any faster.”
but this is a ridiculous argument. with less time on paperwork, there is more time for learning. with more time for learning, though the rate of learning does not increase, learning increases.
Someone interested in medical student and resident education said
April 18 2007 @ 2:11 pm
to sam,
you would think that would be the case, i have not yet seen that come to fruition. there are a lot of things that are good in theory. the expectation would be that the extra time be spent learning (i.e. reading). in my experience, this doesn’t always occur. i can give many examples, but i will give just one. i was in the OR with a new resident on our service (although he was PGY-4). we are doing an open reduction of a hip (DDH). i ask a “bold face” question (meaning it is bold face in the books with pictures) and a common question on the boards. nothing hard not tricky. blank face he had no idea. how do you expect to learn if you haven’t even prepared for a case you had 1 week to prepare for? in the past we would just beat the residents, now that is frowned upon (just joke folks, just jokes)
Panda Bear said
April 18 2007 @ 2:13 pm
Right. I can’t see how an orthopedic residency program where the great majority of procedures are elective or at least non-emergent can’t schedule enough OR time for the residents in the 13 hours per day, six day work week that they have available to them.
Hoover said
April 18 2007 @ 2:59 pm
The inefficiency comes primarily from the programs and/or hospitals. Residents pretty much do what they’re told to do. Just like Panda said, he was made to do some meaningless task that could have been done much more efficiently by pre-printing the discharge summaries. It is up to the hospital or program administration to get the forms printed up so that residents don’t have to write them out by hand.
Who is the bright hospital CFO that determined it is more productive and financially sound to have a resident physician hand write forms versus having a pre-printed version with blanks to fill out? That’s a perfect example of what I’m talking about.
The hospitals know that a resident will do the work, so they don’t have to go to the trouble to make sure that forms are pre-printed and are on hand for when a resident needs to use one. The programs and hospitals have been lazy for so long, that it’s simply expected that somebody else will do the scut.
Give me CFO control of one academic training program hospital, and I could guarantee you that I would increase productivity, decrease costs, and increase ROI within a year. And I bet you I could do it with decreased resident work hours across the board.
Someone interested in medical student and resident education said
April 18 2007 @ 3:51 pm
couple of things to clear up. we can’t schedule 13 hours worth of elective cases we are constrained by OR policy. the number ORs begin to decrease at 3pm, therefore there is a limitation in the number of cases one can perform. the number of rooms you can run at once is also an issue because of medicaid resrictions (well we can run them but no bill can be issued).
another thing is that for a department there is no real CFO. the hospital has one, but department billing and hospital billing is separate. many academic centers have physician groups who do work with in the hospital. most academic practices are multispecialty groups, incoporated separate from the hospital. i model of this is harvards group. our group works 3 different hospitals all of which have loose association to the university and no financial ties.
undestand that there is a coplex relationship between the hospital, physicians, and university.
Cherokee said
April 18 2007 @ 4:38 pm
“Someone interested in medical student and resident education”: So what if the resident didn’t know a bold-faced question? BIG DEAL. Maybe he’s doing a TON of scutwork for the past week that you aren’t doing as an attending. How long have you been an attending? 25 years? Pimping pisses me off.
Someone interested in medical student and resident education said
April 18 2007 @ 6:49 pm
i guess asking a question to figure out if the young doctor knows what he is about to do is pimping. truth is he didn’t, should i expect that he knows the basics of the procedure he is about to perform. i think so. if he knew, i let him go until he gets stuck then i step in. he didn’t have a clue. so he got to watch. in my or, you do as much as you are prepared for. it is your case to lose.
Half MD said
April 18 2007 @ 7:49 pm
One thing also worth noting is that the resident salary of $40,000 is after receiving a doctorate’s degree. In the United States, the per capita GDP is $43,500 and the education of the average American is much lower. What’s happened to residency is a real tragedy. I’m already nervous about what I’ll have to undergo—and I have two years left of medical school.
Cherokee said
April 18 2007 @ 8:34 pm
Someone interested in medical student and resident education: You actually sound like a fair-minded person. So I didn’t mean to be an SOB. A resident surgeon should WANT to do as much as possible. I do think residents should be held to a higher standard than medical students, since they are training in the specific field they want to pursue.
Panda Bear said
April 18 2007 @ 10:02 pm
I appreciate the problems you face scheduling OR time, really I do, but if the number of available ORs starts to decrease at 3PM, by five, at least at our hospital, the OR floor is a ghost town. So why are the surgical residents still hanging around?
I know. It’s to follow-up on patients,do consults, and handle the paperwork. All perfectly reasonable functions but since the whole day can’t be devoted to OR time, these functions could be worked into the schedule except that there is no penalty for wasting the residents time. If you were paying the residents overtime for every hours over forty I bet things would tighten up quickly.
The extreme case is the surgery preliminary year where every resident I have talked to who endured one has assured me that their entire purpose was to crank out the scut work and they rarely got within smelling distance of the OR.
I gotta’ tell you. EM has the best system. We have shifts and we work pretty hard but we do get days off and the opportunity to get a good night’s (or day’s) sleep. Additionally, we work closely with out attendings on every shift and the teaching is regular and expected, not something incidental. We also seem to work in a real team environment and the egos, at least in my experience, are minimal making it a pleasure to work for most of my attendings.
Midwife with a Knife said
April 19 2007 @ 2:42 am
I absolutely think that you should know the basic anatomy and steps of every procedure (except maybe an emergency procedure that you didn’t have time to read about the night before) before you ever step into the OR. Especially if you’re a PGY4. If a resident is in the OR with me for a schedualed procedure and they don’t know the anatomy/the steps/etc., they’re holding retractors for the procedure. Maybe closing fascia.
I also think that a 40 hour work week within medical training is impossible without making our training longer. After 4 years of undergrad, 4 years of medical school, 4 years of residency, and now working on 3-4 years of fellowship, I’d rather be in the hospital more than spend more years in training. Part of experience is just being in the hospital enough to see things you haven’t seen before. ESPECIALLY in surgical specialties.
I actually don’t think that the low pay is that big a deal either. I mean come on, yeah, the pay sucks, but resident pay is closer to being a living wage now than it used to be, and really, it’s just for a few years.
My biggest problem is that every time the administration of any hospital has some cockamamie idea to add 19 hours of paperwork to each admission, the attitude is always, “Oh, that’s ok, we’ll have the residents do it”. The best solution to this would be to reduce the amount of paperwork involved in medicine as a whole, but since nobody listens to doctors any more, I don’t know how to fix that. But I think that fixing that problem is the key to fixing medical training.
Panda Bear said
April 19 2007 @ 4:02 pm
I never said that medical training needed to limit itself to 40 hours per week, I just suggested that if the hospital had to pay overtime they would be a lot more careful with their residents time which even you will agree is wasted in job lots. If you’re paying extra for the 19 hours of paperwork you might not be so gung ho to have it done. Non-academic hospitals, while still paper mills, don’t have nearly the red tape as academic paper mills.
As for the residency salary being a living wage, well, speak for yourself. Of course you can live on it, even with a family of six (and five dogs) like I have. But that ain’t the point. You might as well say the same about any job, including that of an attending physician. Seriously, if you think that a guy like me can live on $40,000 a year just nicely then why can’t you once you become an attending? If you ask me, not only is it selfishness on your part to expect more but it is unnecessary because all we really should expect out of life is a living wage.
As for it only being a few years, well, that’s like a car dealer telling you that it’s only another five hundred bucks.”
Yeah, motherfucker, but it’s my five hundred bucks (or four years).
It’s this menatality, the you should be happy with what you get, that is an obstacle to any reform.
And, let me reiterate, I don’t care that my attending will have to work harder if I am not his slave or that he thinks it’s not fair that those new-fangled residents didn’t have it as tough as he did. That’s his loss and his heartache, not mine.
And again, screw all that talk about the “team”. Team is a sacred workd in our sports-crazy society and rightly so as it calls to mind all of the finer aspects of the human spirit. They call the medical training paradigm a team but that’s horseshit. I’ve been on teams, both sports and military (fireteams, Battalion Combat Teams, etc.) and many of the rotations I have been on are nothing like a team at all.
They call them teams to make you feel bad for complaining about how crapulently you are being treated but I, for one, am well past falling for that one.
Med Stud said
April 19 2007 @ 7:17 pm
Re: “Just a few years”
Keep in mind that for some surgeons, “just a few years” quickly ends up being 10 years and in rare cases, even more than that. 7 year general surgery program with built in 2 years of research, with a 2-3 year fellowship, which is virtually required these days. Some go onto to specialize further, for example, pediatric cardiac surgeons must do general surgery, cardiothoracic fellowship, then a pediatric cardiac fellowship.
Someone interested in medical student and resident education said
April 19 2007 @ 7:28 pm
dr. bear never thought i would see you bring up a subject such a the “team” and the say forget about all this talk about team. (smiley face) you know there is a problem with both hours and wage; on the same note the needs to be education. when most are done they will pay for the required CME course and that ain’t cheap. so how much is the “required” education worth? that varies i guess. but it isn’t cheap. to ask for the same salary as a seasoned PA or NP who can work independently and bill, is probably not right either. there is a happy medium somewhere. fortunately for my specialty we probably ask for tuition and fill. but it is not the same for others.
i truely believe that we (attending, resident, and med stud) have a sembiotic relationship and should respect that. also respect is something that is earned, in both directions.
again, i think we speak a lot about the time (80 hrs) and sometimes lose sight of the education that is also needed. for me (i can’t speak for anyone else), i expect people to come to work to work. in at 630am done by 6p, sometimes earlier. 5 days a week. i have 2 OR days and 2 resident supported clinic days and 1 i run by myself. my chief runs the service as far as residents and distribution. we have a good time. work doesn’t always have to be so serious all the time. i tease (heckle) them and the give it back. (please dr. bear don’t yell at me for saying heckle) we are a TEAM. our hiearchy is more like a small hill than a mountain.
well that’s all i got. to those who have commented on my blog i will post them. i am out of town and can do anything on the blog on my blackberry, thanks for the input though.
Hoover said
April 19 2007 @ 7:29 pm
That’s something that has always irked me too. Other students and residents used to tell me “you can do anything for x number of years or x number of months.”
Sure, I could do it but that doesn’t mean that I want to or that I will. After all, it is my time. I’d rather spend it doing something that I was actually happy about doing.
NocturnalDoc said
April 19 2007 @ 9:10 pm
Watch the news? Cook? You DO that? Are you kidding me?
Hoover said
April 19 2007 @ 9:51 pm
I watch TV and I cook from time to time.
=)
NocturnalDoc said
April 19 2007 @ 10:55 pm
I did my residency before work hour regs….for me there was no tv and cooking involved a microwave.
Couple quick things: try answering pimp questions after 50 straight hours awake on “call.” Mostly I just stared at the lights and thought “ohhhhhh pretty!! Shiny!! Must touch!”
“we are a TEAM”
Usually stated by the guy at the top of the totem pole. Shit rolls downhill.
Hoover said
April 19 2007 @ 11:04 pm
Ahh, but I’m not in residency Nocturnal.
=)
Cherokee said
April 20 2007 @ 12:12 am
Hoover, you did medical school but no residency? *GASP* Isn’t there a law against that or something?
Panda Bear said
April 20 2007 @ 8:32 am
1)I ain’t asking for the same salary as a seasoned PA who can bill n’ everything. But a fresh PA just out of their awesome 2.5 year training program can start anywhere from 60K to 80K so it’s insulting to start somebody with four years of training at $39,000.
2) Whether or not residents directly bill or not, their work is worth money to the hospital. It is a bureacratic shell game that lets The Man hold up the books and say, “See, the residents don’t make me any money.”
3) The seasoned PA would quit if you made him pull Friday-Sunday call like I have done once or twice a month for almost the last two years. He’d work his “40″ over the weekend (but more like 56) and that’s all he would do. Not only do you pay the PA twice to three times what your pay your slaves but they work many, many fewer hours.
Panda Bear said
April 20 2007 @ 8:36 am
Besides, you are as much as admitting that there is no need to keep the residents for even eighty hours a week, seeing as you have wonderful PAs that can bill n’ everything. Let them do all of the scut work and just have the residents come in for the medical stuff.
If they are otherwise useless and a drag on your bottom line, hell, I’d be horrified to have them spend any more time in-house than absolutely necessary.
Panda Bear said
April 20 2007 @ 8:43 am
I reiterate, fuck the “team.” There is no team unless by team you mean a system where some of the team are treated like crap, worked for low wages, and disciplined when they complain to the team captain or try to switch teams.
It’s just a job. That “team” crap is used like “patient care,” as blunt instrument to beat the house staff down and make them feel guilty for wanting some time off or better pay.
Someone interested in medical student and resident education said
April 20 2007 @ 8:59 am
dr. bear,
you know what they say when u assume.
i can only speak for my practice and how as a department we have adapted. 1st most floor scut and phone calls are screened by our NP (with 20 years experience) she does discharge paper work, wheelchair ordering, home IV abx, etc. she is the glue that keeps the service running and she knows the politics and history. she does FMLA’s, school notes, and answers parents phone calls.
the PA’s don’t go to OR because with residents we can not bill for them in OR. so they run clinics, they do the specialty clinics (CP) and outreach. this frees residents up for OR. they run their own clinics as well.
at our, other hospital (private) pa’s are in house and cover the call for trauma and floor.
on the trauma service, well it’s trauma tends to be busy. the PA’s do paperwork and there is a casting specialist.
for my department, i can say we are resident advocates. oh did i say their lecture time is protected.
for me the PA’s serve as midlevel providers and do not detract from the rsident education. we truely function as a team with everyone having a role and willing to step in the what ever role is needed. attendings included. in the end it is about patient care.
Panda Bear said
April 20 2007 @ 10:29 am
The PAs do not cover the call, at least not like residents. Just recently I was rotating on a service where my presence was a complete waste of time and money for all involved (NICU) and they had a Nurse Practioner who came in at night for “call” to cover things so the fellow could get some sleep.
The NP asked me to do some of her paperwork when I was on call which I refused. It was early, early in the morning and I was trying to get some sleep. She became irate and layed that line on me, “Well, I’m here and I’m awake.”
To which the natural response was, “Lady, you’re working a shift and you had plenty of time to sleep today before you came in. I’ve been here since six AM yesterday and I won’t get to leave until one PM today. Do your own goddamn paperwork and if you have medical emergency or something that I can help you with or soemthing valuble you can teach me then call…but the paperwork can wait.”
Just the idea that I’m supposed to be a paperwork scut-whore for a mid-level providor should be repungnant to anybody and why I say, fuck the “team.” It ain’t a team at all but a system of indentured servitude.
So it may work differently where you practice but this is not typical. The residents work full-time jobs and they have to cover call at most places. In other specialties, particularly medicine, the residents are fairly interchangeable after intern year so they may cover all of the specialties (cardiology, pulmonary, etc.
Someone interested in medical student and resident education said
April 20 2007 @ 11:00 am
i agree PA call cverage is not the same, it is an adaptation to help bridge the gap. our practice is different. we have adapted. we are also in a high yield specialty. i worked harder than our residents and had a harder life than my children, i don’t excpect them to undergo the same. but, as the wise rodney king once said “can’t we all get along?”
Panda Bear said
April 20 2007 @ 4:50 pm
We can get along. I get along with everybody and I am not blaming you for the current system, just like I don’t blame my attendings. The system is what it is.
And again, I am not stating anything complex although my private email at pandabearmd and many of the comments ascribe a level of angst to me and my blog that simply does not exist. There is nothing more metaphysical to it than I hate working long hours, most of which is wasted time, for peanuts and I hate going without sleep on a regular basis.
Incredibly, this is the last call month of my medical career.
Med Stud said
April 20 2007 @ 6:39 pm
http://archsurg.ama-assn.org/cgi/content/full/142/3/249#SOA60006T1
“The largest blocks of time before reorganization were taken up by rounds, especially morning rounds. Reorganization had the most noticeable impact on round times, but improvement was also seen in outpatient clinics, and there was an increase in time spent in operations for both junior and senior residents. Miscellaneous time was all but eliminated because residents did not have nonpurposeful work in the hospital. Since total work hours per week remained unchanged, the net effect was a shift of time use from rounds to the operating room, reflected by an increase of operations performed by both the junior and senior residents.
Punctuality at conferences, operations, and clinics all improved. The organized rounds contributed to an unforeseen benefit of improved professionalism and communication skills with patients, as evaluated subjectively by attending physicians. The resident survey showed strong scores for improved work satisfaction and reduced work-related stress and frustration due to perceived waste of time.”
Kypdurron5 said
April 21 2007 @ 3:01 am
Panda: >
I hope I’m not taking this out of context; but do you really mean this? These socialist ideals make me shudder! >) I completely agree that residency is a “living wage,” heck my (birth) family of 5 lived happily on about $20k/yr. I would also agree that all a high school dropout working for minimum wage should expect is a living wage…but a doctor who’s at least 8 years into post-secondary education? Plus, this whole blog (and many others) are devoted to how horrible it can be both getting there, and being there. I can honestly say I’ve never seen something like this for accountants or janitors. Maybe residents aren’t yet fully-trained physicians, but going through all that education and putting up with all the crap along way is surely worth something more than a bare-minimum of a living wage!
On a different note…I haven’t seen anyone consider the ramifications of residency programs increasing compensation. It’s well and good to suggest that hospitals be required to increase efficiency through mandatory overtime and the like (which would in turn lead to a reduction in scut work for residents). However, if residents are treated more like doctors and less like paperwork whores, wouldn’t this invariably lead to an overabundance of personnel in physician-related positions? I see cutbacks in residency spots, which are already not exactly in surplus. Add to this the fact that each resident may now cost more because of overtime, fewer manpower hours worked, paperwork that must now be completed by other paid personnel, etc. and I see more cutbacks. Who ever decided that residency should be paid in the first place? It’s not like residents can be utilized as full-fledged physicians yet, and without residency this would never happen….so couldn’t the argument be made that residents need hospitals more than hospitals need residents?
Someone interested in medical student and resident education said
April 21 2007 @ 11:44 am
krup 5, i can speak a little to the latter staement. not all hospitals are not the same and some have come up with general care plans for commonly seen things at that hospital. for instance, in ortho many have come up with general care plans to decrease some of the paperwork demands with preprinted orders or EMR orders. most of these things come down from the network or hospital system so generally take a while getting through.
as far as resident work force, i can tell you what i have seen so far. residency programs switching to fellow only programs; rotation only resident education to fill holes of a residency program; then residency closures. in the UK with the overall decrease in work hours, they have seen an increase in the number of residents graduating without an increase in available positions (in the specialties).
i think the easiest thing for a department to do is say fuck it, and let the residency falter, higher midlevel providers and move on. it definitely frees up time, no more lectures to give, no teaching rounds, no early morning conference (my least favorite). probably a bit easier at a community primarily private practice residency.
i think that as someone on academics, i feel more of an obligation to continue in educating young physicians because we need to replenish our flock. in truth we need each other. you, as someone in training, need to be trained; we as trainers need the workforce. even though you can be replaced on the front end, the final result can not.
Panda Bear said
April 21 2007 @ 12:24 pm
Kypdurron5, despite what Someone Interested etc. says, there is a huge demand for cheap medical labor in most academic teaching institutions. A place like Duke, for example (where I did my intern year) not only sees a net profit from their 1000-or-so residents in the neighborhood of from 30 to 40 million dollars per year just from the money paid by the government to fund resident education, but they also make money from “non-billable” work which is none-the-less claimed by their attendings and save an incredible amount by having residents covering the call schedule on many services for free.
Yes, for free. The residents salary and benefits are paid for by the government. Not only is this no-cost to the hospital but the stipend, which also subsidizes free care for the poor, is a source of profit because, (and Someone etc. doesn’t understand this at all) money is fungible. All the money, despite the hospitals complex accounting designed to keep money hidden, goes into one pot. Saving on a mandatory expense (free care) is the same as making money.
I betcha’ if every resident walked off of the job most of the county’s charity hopsitals (like my Alama Mater in Louisiana, would collapse. Either that or the State would have to cough up some real money to get the same coverage they get for free.
There is a little LSU hospital in Monroe, Louisiana, for example, that serves the poor of that poorest city in the United States, which could absolutely not function if it’s obstetrical, surgical, and primary care functions were not staffed by residents. Those patients would end up at the various for-profit hospitals in town and that would be that.
I’ll tell you what. I’ll give up my salary if you just pay me the hourly wage of a PA for only the nights I am on call. I’ll work the days for free, you understand, and just bill for the 14 hours between 5PM and 7AM. Since I have been on call an average of seven nights a month for the last two years, that works out to…let’s see…about 2300 hours over the last two years at about 60 bucks an hour which is about $120,000 bucks or $60,000 per ytear just for covering call. Now the fact is that call i
Panda Bear said
April 21 2007 @ 12:27 pm
Correction, that’s $140,000 for two years or 70K per year.
Keep in mind my hospital gets $100,000 per year for me whether I work or not.
Panda Bear said
April 21 2007 @ 12:33 pm
In other words, Someonetc maintains that the hospital would save by eschewing residents and going to PAs to cover call but this is ridiculous. PAs will cost you money, residents do not. Not only that but a good second or third year resident is lightyearss ahead of his PA counterpart in his knowledge and abilities. Maybe not in a narrow specialty like Ortho but I’m sort of a generalist and cover, on call, general medical problems which are not always trivial.
If call is bogus, on the other hand, and doesn’t really need to be covered, then why make the residents do it at all?
Don’t drink the Koolaid. Residency training is a money-making and money-saving enterprise where the hospital, in the ultimate buyer’s market (considering the desperation of the typical pre-med to get into medical school)can run what was until very recently, a completely legal sweatshop (which is what the AMA called the system).
Panda Bear said
April 21 2007 @ 12:38 pm
As for lectures and teaching, well, that’s the price that academics pay for choosing to work in teacing hospitals. It’s not that much of a drain. It’s not as if residency is set up for continuous lectures. Considering the money residents make and save for the hospital the usally scanty lecture and conference schedule is an insult.
Besides, the residents give most of the conferences in case you all hadn’t noticed. Maybe Grand Rounds involve an emminent and distinguished professor but most of the conferences are given by the upper-level residents.
Sho’ enough.
Someone interested in medical student and resident education said
April 21 2007 @ 2:23 pm
dr. bear,
as he would like to point out that i don’t understand how a hospital billing system works. lets talk about what i do know. hospital and physician bill is separate. facility fee an professional fee. in truth most hospitals don’t care who does the job as long as it gets done. see the professional fee is so much smaller that they could give a shit. medicaid payes the hospitals well.
i can also speak from 3 separate practice experiences which include academic and private. many private hospitals function without a single resident. hmmm how could that be. most of the practices i have been involved with have gone to the mentality of functioing services without residents. this is so when they are gone vaction, post call, paternity leave, we can function without them. i use to believe that community facitilities would fail without residents, the the DMC has proven me wrong at least this year.
the billing with a resident is different than with a PA or NP. a PA can bill for care without the physcian. an NP can as well and they are less restrained by the physcian. for most services the extended care providers billing covers their cost. say in surgey i can bill both a surgeon and 1st assist fee, but not with a resident.
large traditional academic institutions like duke (which is worst than most) and my alma mater michigan have such a superiority mentality that they probably won’t change until the government mandates it. what many academic institutions are learning how to make money with extended care providers.
i am a resident advocate. i really can only tell you what i see and have heard others on the darkside discussing. this is a big discussion at our institution where we get a lot of our resident funding from medcaid, yes medicaid not medicare (this was news to me resently came out in the press). president bush has put that on the chopping block. so much of this discussion is well into my arena.
Panda Bear said
April 21 2007 @ 3:42 pm
They function without residents because they a) Are not charity hospitals that take everybody. (In Louisana almost all of the indigent patients, even if they present to a for-profit hospital eventually make their way to the LSU system.) b) They pay hospitalists to cover the wards and admit patients at night and c) They are just not as busy. (I rotated at a small, private hospital and the not only was the pace incredibly slow but the patients were a lot less sick than at LSU)
But let’s give you the benefit of the doubt, if residents are useless, then why on earth am I getting stuck with q4 call every month and pulling two Friday-Sunday calls this month?
I assure you our hospital would collapse without the house-staff. Either that or, and this is something you seem to be missing, they would have to hire either midlevels or hospitalists to cover all of the services in-house at night. Our hospital pays moonlighting residents 80 bucks an hour to cover the gaps in the call schedule and this is not just charity but the market price for somebody to be in-house.
Which is my point. You seem to be saying that a) Residents are worthless and do no usefull work and b) If we didn’t have residents we’d just hire soembody to do their job. Which is great but nobody you hire is going to work for nine bucks an hour. Nobody, that is,unless you feel comfortable having an LPN being responsible for your patients.
And look up the word “fungible.” I don’t think you understand it. In the case of residency, it means that the resident’s labor is exchangable for somebody’s who would make a hell of a lot more, usually ten times more, so this is the same as printing money to the hospital. If I see twenty patients in a shift and the attending only has to expend five patients worth of time supervising me (which is about how it works) he still has a net gain of 15 patients for whom he bills.
Residents do not, repeat do not see patients for free, at least in my specialty, family medicine, and internal medicine. I don’t know how it works in surgery where your residents may actually be a drag for many years. Somebody else just takes responsibility and credit for them. (Not on every rotation, of course, like my two weeks in the NICU where I was, indeed, useless. But I know when I’m useless and when I’m being jerked around.)
Someonetc said
April 21 2007 @ 6:58 pm
dddddddddd1st off i would like to thank our wounderful host hoover for have me on his forum. second i’d like to thank my sponsers from the darkside.
ok, i would like to clear up one point “i never said residents were worthless” (pointing my finger like bill clinton but actually telling the truth). i did say we could not bill for them.
let’s clear up some of the physcian billing that is allowed by HCFA. as far as billing, medicare dictates that a physcian (attending) can bill for work do by a resident under his/her supervision. the specifics of in-patient billing as far as admissions and in-patient notes, you would have to refer to the specifics for the E&M codes and guidelines. we don’t try to capture those bills. for consults, we see them dictate no charge unless we do a procedure. ER visits are captured by the attending ED physician (this includes facture reductions).
now lets talk out-patient. i can see about 20 to 30 patients in a half day clinic by myself. with a resident, i can see 20 to 35 in a half day, limiting factor i me. i have to actually see them all, do a little exam and have some discussion with the family. with a PA i can see 20-30 (me only) plus the PA can see 15-20 followups i do not have to see. in this case, the clinic is unloaded of low yield stuff post ops, f/u for the ambiguous leg pain allowing for new patients to be seen. higher charges generated by new patients and more complex patients. so that is a little of how th PA helps a outpatient service. inpatient surgery services can use them for post op care and initiating consults. they are also used as first assists, billable services. as an independent physcian or physician in a group practice, i see no personal dollar benefit from the resident on my bottom line. and djdd
Someonetc said
April 21 2007 @ 7:49 pm
sorry my blackberry went crazy.
as far as hospitals functioning without residents, it can happen and even at the busier hospitals they have adjusted very well, those with money. places like good old county hospitals (cook county, grant, good ole charity (rest her soul)) suffer and will close like so many have forcing most of that care to the universities. extended care providers once experienced function at the level of an upper level resident (and i have seen some who were better than some attendings) but their scope of practice is limited.
i pesonally feel an obligation to the medical feild to help young minds gather the knowledge and assure that we put out a good product (attending surgeons). i am salaried and i took a $100,000 paycut (and i had residents before) for a practice that i enjoy with people i respect. for me it is not about money, it is about doing what you have a passion for in an environment that is supportive with people who feel the same. i consider myself an educator. i love to see my learners grow. i speak about the benefits of the mid level provider not because i personally get a financial benefit but because i have some experience in dealing with them.
there are significant changes coming in the future with more hospitalists groups being used in hospitals and more extended care providers bridging gaps. systems like harvards system are already adjusting with practice plans that are benificial for clinical faculty and that enhance residency programs. how residents are payed my change. when residents are NOT funded and are payed for by the institution or department their work may be billable as first assist or similar to PA’s and therefore increase the salary. we see this in non-Acgme acredited fellowships.
so, there is no doubt that residents work hard for low salaries. and on the same note, residents can help take care of each other and panda as the non categorical reisdent sounds like you got the shaft with call. we use to see that with our residents until we changed the requirements (i don’t think the 2 months on the transplant sevice helped me at all).
sorry for the long comment. and panda thanks for the Someonetc. i like it. your so smart.
Panda Bear said
April 22 2007 @ 8:08 am
First of all, if your clinic is inefficient bacause of residents, this is not typical of what I have seen. I have done a total of five general and trauma surgery rotations as a resident and in every one, the clinic moved at a pretty good clip and the attending did not spend that much time with the patient.
In Emergency Medicine and Family Medicine, the attendings see their own patients and offer brief (but concise) supervision on yours. It does slow them down a little but on the other hand, the total throughput of the clinic or the department is increased. At the end of the day, the attending gets all of the “encounter sheets” for the day and makes sure they can be coded correctly, under his name.
You’re trying to muddy the waters here. The mechanics of billing and collecting are fascinating but irrelevant. The work is “fungible” which is the cool thing about slavery, namely that nobody gives the Hebrews credit for the building the pyramids. (History buffs stand down, I know, I know)
Panda Bear said
April 22 2007 @ 8:10 am
I am a categorical resident. And I was last year, too. Everybody gets the shaft.
Someonetc said
April 22 2007 @ 8:48 am
residents don’t slow me down patients do. i have to see every patient (based on guildelines by HCFA) so in that instant i am the limiting factor. i can have 10 residents but it doesn’t allow me to see more. with a PA i am not the limiting step. and yes resident work and they learn (at least on my service) so when do you separate work from education? in my view(for me), every day is a school day. i learn one new thing each day. the med studs are a wealth of knoweledge. yes my residents constructed several piramids but not without me being present for the “key portions of the construction” which is most of the construction on my constuction site.
and i can tell you the bill doesn’t cloudy the water, it is a reality of medicine today. like lawyers, we need the billable hours. as a department it is how we stay solvent. it is why many specialties otho, cards, derm, neuro surg, would like to pull away from a group so they don’t support family, peds, etc. i can tell you that is the primary focus of faculty meetings, not how can we screw the residents
and yes i know you are categorical resident in 1st family then EM, i also know in EM there is no call, therfore you must have been on another service, not EM. see there where 4 weekends in the month (full weekends) and you had 2 friday-sunday calls, i think you got screwed. does the hospital make your schedule?
Midwife with a knife said
April 22 2007 @ 12:51 pm
Someoneetc and Panda, you seem to be comparing different things. I think that the issue is that having residents may not be the most cost effective for any individual attending (depending on how your department is set up, if you can qualify under a “primary care” mandate, attendings can bill for patients seen by residents that they did not see themselves, but if you don’t (and ortho probably doesn’t), an attending has to lay eyes and hands on every resident patient. This isn’t the case for an attending working with a PA or NP. So, even though the resident may be free help for an attending, if a PA or NP could see 10-20 patients/day and bill without having the attending seeing them, they may more than pay for themselves.
For the hospital/hospital system as a whole, it is extremely cost effective. They get $110k/year per resident, and that is at least enough to cover resident, benefits, malpractice. So… lets say that the resident costs them nothing. (I bet the resident costs less than the hospital is reimbursed for, but I don’t have the numbers) That resident who costs the hospital nothing takes care of 10-30 patients/day (depending on specialty) with cursory (and often “indirect”) supervision. If an attending or NP had to see every patient our residents send out of Triage each year, it would be extremely expensive for the hospital. Attendings don’t see postpartum patients, and they simply sign the delivery paperwork (they may or may not attend c-sections or deliveries).
So, at least on the obstetrics service, our hospital would not be able to provide the level of uncompensated care it provides if it weren’t for the battalion of residents. Can you imagine if all of the ICUs in a major tertiary care center were staffed by PAs 24/7, or if all of the medicine inpatients were supervised by NP/PAs 24/7? Where I was a resident, the NPs (who are good at what they do) were really out of their depth when a patient was either really sick or when people didn’t know what was going on with them.
Someonetc said
April 22 2007 @ 4:12 pm
i would agree with midwife with a knife. i am ignorant of other services billing practices.
i would also agree that large hospitals with a large amout of selfpay (a nice way of putting no pay) patients will have a difficult time surviving with decrease in resident hours. see the collapses of many county hospitals which were primarily resident run hospitals. those systems have less cash flow and can not with stand large shifts in capital. large universities have large endowments and will survive.
i worry about the system it is definitely in the mist of upheavel. what you as learners may not see is academics is no longer a protected area. we are very much effected by cash flow. this has become more of an issue than in the past. although some institutions still push the research end, most want you to bring in funds “by any means necessary.” grants are hard to get, the easiest way is to generate clinical income. now it is more like a private practice model. so if residents now only come in for the good cases (teaching points) take minimal call and i have to do all my own paperwork, admissions discharges etc. then why don’t i just go into private practice? in the end you will see less dedicated educators. imjussayin.
Midwife with a knife said
April 22 2007 @ 4:53 pm
someone: That is probably not even good for the residents. At least in OB (and I imagine every specialty has its equivalents) you have to see 300 normal deliveries for every catstrophe. That means that even though the umpteenth normal delivery might feel like scut for an OB resident (maybe even the equivalent of wound care in ortho?), if you’re not there for them, you won’t see the catastrophic shoulder dystocia or the catastrophic postpartum hemorrhage; so that when you’re an attending, you might be managing the first catastrophic postpartum hemorrhage you’ve ever seen.
People need to be in the hospital a lot to learn the art of medicine. I’d rather be in the hospital 100 hrs/week for 4 years than 40 hours/week for 10 years.
But, ideally, when residents aren’t doing the work of patient care and are at the hospital, they should be reading, eating, learning. They should not be transporting patients (which still happens all around the country), doing blood draws (unless the hospital offers to pay them the wage and overtime a phlebotomist would get), or filling out pieces of paperwork invented by the hospital because, hey, the residents will do it!
Also, the academic centers are going to start having problems recruiting. Attendings aren’t going to want to deal with the b.s. It’s already happening in Maternal-Fetal medicine. I can get a sweet private practice job when I graduate where I’ll make a lot of money, and I can even do it in a place where I’ll be able to teach residents and medical students. (It is important to make sure that there are docs to replace us) I also will be able to do it without the politics of academics, grants, committees, and pressure to produce research (which is usually unaccompanied by the time to do so). Not that there’s not pressure to be productive in private practice, but I understand (from those who are there) that it’s different, and often less annoying than the academic medicine BS I was shielded from as a resident but now get to witness as a fellow. Like how attendings with different connections have different expectations.
So, given that, why would anybody in their right minds in MFM stay in academic medicine?
Hoover said
April 22 2007 @ 6:18 pm
I wouldn’t touch academic medicine with a 10 foot pole. Midwife, I think you’re right. I believe it will be hard to find academic physicians in the near future unless pay and working conditions scale a bit closer to the private realm of things.
Midwife with a knife said
April 22 2007 @ 7:45 pm
Hoover: Yeah. It used to be that academic docs got paid less, but also had more flexibility and less work. I love teaching, and sometimes I think I might even like research (which is good, I have to do 18 months of it in my program!), and I used to have this vision of myself as the physician/scientist/teacher. Now, after having seen how viscious and underhanded the politics are among the attendings in my fellowship (we’ve actually lost >1/2 of our attendings and been unable to replace them), I have no desire to do that. I’ll just find a nice perinatology private practice where people are nice. All I want is to work with nice people who do their jobs.
Someonetc said
April 22 2007 @ 10:15 pm
hoover,
your experience is one reason people don’t want to stay in academics. problem is we need good people to stay inorder to keep the knowledge flow.
since the previous benefits have gone, you get people on ego trips who need it like they need fancy sports car, the people who couldn’t make it in private, and the few who care. as midwife suggested it is hard to keep good people which leaves less to teach. the physician scientist is becoming an endangered species. for me, i like learning. my residents make every case interesting and i make enough that my family is very happy. i could go back to private arena but i got tired of chasing the dollar.
on the surgery side, we are well compensated for our work. but i can’t purchase a mri scanner, and that’s a fricken money generator.
Hoover said
April 23 2007 @ 1:44 am
Most of the physicians that I had contact with as a student were those who either failed at private practice or would fail at private practice should they attempt it. I can’t understand why people so smart choose to act so high and mighty and completely put off the colleagues that they are working with. You would think that these people would learn basic communication skills at some point during their lives (if not during medical training), but it doesn’t seem to be the case.
It’s a shame when the only working environments that they can successfully deal with are the academic ones. I’m serious, private practices would chew them up and spit them out within a week.
I’m not saying all attendings are like this, but this is the vibe that I got while in medical school.
Attending, MD, JD said
October 19 2007 @ 9:06 pm
Excellent. Well said.
Med School Hell » 56 Hour Work Week Is On The Horizon said
May 22 2008 @ 11:53 pm
[…] coming out into the light sooner rather than later. No matter how you slice it, “only” 80 hours per week is the biggest joke I’ve seen in a long damn […]
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