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.
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.
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.)
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
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.
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)
I am a categorical resident. And I was last year, too. Everybody gets the shaft.
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?
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.
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.
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?
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.
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.
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.
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.
Excellent. Well said.
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